Individual provider Active NPI

Riley Jerome Palmer, PHD, LP

  • Clinical Neuropsychologist
  • Fridley, MN
National Provider Identifier
1073342085
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
LP7010 Issued in MN
Practice address
520 Osborne Rd NE Ste 120
Fridley, MN 55432-2718
Phone
(763) 236-4300
NPI assigned
Jul 29, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X LP7010 MN Primary

Addresses

Primary practice location

520 Osborne Rd NE Ste 120
Fridley, MN 55432-2718

Mailing address

206 Cleveland Ave S Lowr Unit
Saint Paul, MN 55105-1104
Phone (612) 723-8632

Other practice location 1

295 Phalen Blvd
Saint Paul, MN 55130-2400
Phone (612) 723-8632

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240819000820 MN Practitioner - Clinical Psychologist 7416495726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

520 Osborne Rd NE
Suite 120
Fridley, MN 55432-2718
Phone (763) 236-4300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Oct 1, 2024 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Oct 1, 2024 Accepting new patients

Locations

520 Osborne Rd NE
Ste 120
Fridley, MN 55432
Phone (763) 236-4300

520 Osborne Rd NE
Ste 210
Fridley, MN 55432
Phone (763) 236-3800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

Interoperability endpoints

  • Direct secure messaging: rpalmer672148@excellian.direct.allina.com

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1073342085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 CLEVELAND AVE S LOWR UNIT",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051104",
            "telephone_number": "612-723-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 OSBORNE RD NE STE 120",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "295 Phalen Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551302400",
            "country_code": "US",
            "telephone_number": "612-723-8632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMER",
        "first_name": "RILEY",
        "middle_name": "JEROME",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-29",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP7010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.