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Individual provider Active NPI

Gregory D Wasberg, MS

  • Marriage & Family Therapist
  • Slayton, MN
National Provider Identifier
1053417758
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
0889 Issued in MN
Practice address
2959 Queen Ave
Slayton, MN 56172-1513
Phone
(507) 836-8636
Fax
(507) 836-8789
NPI assigned
Sep 16, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 0889 MN Primary

Addresses

Primary practice location

2959 Queen Ave
Slayton, MN 56172-1513

Mailing address

2959 Queen Ave
Slayton, MN 56172-1513
Phone (507) 836-8636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240111004831 SD Practitioner - Marriage and Family Therapist 2668823840

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1995
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Sioux Falls, SD 57118-6370

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
0889MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jan 1, 2024 Accepting new patients
Avera McKennan CurrentSince Jan 1, 2024 Accepting new patients
Avera McKennan Current Accepting new patients

Locations

4400 W 69th St
Ste 1500
Sioux Falls, SD 57108
Phone (605) 322-5700

Interoperability endpoints

  • Direct secure messaging: gregory.wasberg@avera.sdhealthlink.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

  • Avera McKennan

    dba Avera Medical Group University Psychiatry Associates Sioux Falls

    • Psychiatry Physician
    • Sioux Falls, SD
    • NPI 1013980598
    NPD
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678
    NPD
  • Avera McKennan

    dba Avera McKennan Behavioral Health Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Sioux Falls, SD
    • NPI 1699009944
    NPD

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053417758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2959 QUEEN AVE",
            "city": "SLAYTON",
            "state": "MN",
            "postal_code": "561721513",
            "telephone_number": "507-836-8636",
            "fax_number": "507-836-8789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2959 QUEEN AVE",
            "city": "SLAYTON",
            "state": "MN",
            "postal_code": "561721513",
            "telephone_number": "507-836-8636",
            "fax_number": "507-836-8789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASBERG",
        "first_name": "GREGORY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "0889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Slayton, MN

Sources for this page

Verify at the official NPI Registry.