Roy John Sutherland, PHD, ABPP,LADC,MHA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP5295 Issued in MN

Practice address

1900 Silver Lake Rd NW
New Brighton, MN 55112-1786

Phone

(651) 628-9566

NPI assigned

Sep 8, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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 and National Provider Directory roles.

• Allina Health System

  dba Allina Health Buffalo Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  Medicare reassignment NPD
• Healtheast Medical Research Institute

  dba HealthEast Vadnais Heights Clinic

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  Medicare reassignment NPD
• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment NPD
• Allina Health System

  dba Allina Health St Michael Clinic

  • Clinic/Center
  • Saint Michael, MN
  • NPI 1881990521
  NPD
• Allina Health System

  dba Allina Health TeleRheumatology

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD
• Healtheast Medical Research Institute

  dba HealthEast Professional Services

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552

  Psychologist

  NPD

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

{
    "created_epoch": "1283904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1073820379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "ROY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PHD, ABPP,LADC,MHA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-08",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP5295",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073820379",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dzenita Subasic, PHD
• Mark Elmer Sundby, PH.D.
• Sunshine Healthcare LLC
• Superior Health Care Services LLC
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Lucas Swingley, PHARM D
• Christine J Tamez, MA, LMFT
• Sarah Taxis, MA
• Teri a. Wylie, M.a., LP
• Heather Rochelle Teske, RN, CNP

• Psychologist in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.