Individual provider Active NPI

John Lichtsinn, M.D.

  • Psychiatry Physician
  • Spring Lake Park, MN
National Provider Identifier
1063739266
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
55108 Issued in MN
Practice address
7766 Highway 65 NE
Spring Lake Park, MN 55432-2832
Phone
(763) 205-4843
Fax
(612) 416-2085
NPI assigned
Apr 27, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 55108 MN Primary

Addresses

Primary practice location

7766 Highway 65 NE
Spring Lake Park, MN 55432-2832

Mailing address

7766 Highway 65 NE
Spring Lake Park, MN 55432-2832
Phone (763) 205-4843

Other practice location 1

1345 Mendota Heights Rd
Mendota Heights, MN 55120-2006
Phone (651) 313-8080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230607001545 MN Practitioner - Psychiatry 2365809381 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Minnesota Medical School, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

7766 Hwy 65 NE
Spring Lake Park, MN 55432-2832
Phone (763) 205-4843

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
55108MNMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Expanse - a Minnesota Mental Health Ketamine & Psychedelic Psychother CurrentSince Jul 31, 2024 Accepting new patients
Nystrom & Associates, LTD PastSince Apr 13, 2026 Accepting new patients
Group Health, Inc. Past Accepting new patients

Locations

2701 University Ave SE
Minneapolis, MN 55414
Phone (612) 627-3500

7766 Highway 65 NE
Spring Lake Park, MN 55432
Phone (763) 205-4843

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1063739266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7766 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322832",
            "telephone_number": "763-205-4843",
            "fax_number": "612-416-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7766 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322832",
            "telephone_number": "763-205-4843",
            "fax_number": "612-416-2085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1345 Mendota Heights Rd",
            "address_purpose": "LOCATION",
            "city": "Mendota Heights",
            "state": "MN",
            "postal_code": "551202006",
            "country_code": "US",
            "telephone_number": "651-313-8080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICHTSINN",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-27",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "55108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Lake Park, MN

Sources for this page

Verify at the official NPI Registry.