Timothy Ryan Rysavy, PSYD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP6105 Issued in MN

Practice address

251 County Road 120
St. Cloud, MN 56303-4872

Phone

(320) 258-3833

Fax

(320) 253-5741

NPI assigned

Feb 22, 2017

Last updated

Feb 22, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Group practices

St Cloud Neurobehavioral Associates PAGroup PAC ID 7113829862, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• St. Cloud Neurobehavioral Associates PA

  • Medical Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1871555441
  Medicare reassignment Care Compare group NPD
• St. Cloud Neurobehavioral Associates, PA

  • Cognitive & Behavioral Psychologist
  • Saint Cloud, MN
  • NPI 1043860109
  NPD (past)

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1073052163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 230",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563770230",
            "telephone_number": "320-258-3833",
            "fax_number": "320-253-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 COUNTY ROAD 120",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "563034872",
            "telephone_number": "320-258-3833",
            "fax_number": "320-253-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYSAVY",
        "first_name": "TIMOTHY",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Rutten, RPH
• Breana Ruud, BCBA
• Elizabeth Ryan
• Michael Paul Rydberg, LICSW
• Richard L Rysavy, M.D.
• Carolyn Dee Rysgaard, MD
• Kimberly Marie Rzeszutko, DPT
• S.B. Consulting L.L.C.
• S&H Transportation LLC
• Inayah Malikah Saadiq-Hasan

• Psychologist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.