Active NPI
Joseph James Bauer, MSE., LP
- Psychologist
- Stillwater, MN
National Provider Identifier
1083717433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP0332
- Practice address
- 11010 Pawnee Ave N
Stillwater, MN 55082-9592 - Phone
- (612) 817-5487
- NPI assigned
- Sep 7, 2006
- Last updated
- Mar 11, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP0332 | MN | Primary |
Addresses
Primary practice location
11010 Pawnee Ave N
Stillwater, MN 55082-9592
Mailing address
11010 Pawnee Ave N
Stillwater, MN 55082-9592
Phone (612) 817-5487
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 634050400 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260324001686 | MN | Practitioner - Psychologist Billing Independently | 6901380351 | Practice locations: Stillwater, MN |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1985
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
11010 Pawnee Ave N
Stillwater, MN 55082-9592
Phone (612) 817-5487
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP0332 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1083717433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11010 PAWNEE AVE N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550829592",
"telephone_number": "612-817-5487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11010 PAWNEE AVE N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550829592",
"telephone_number": "612-817-5487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUER",
"first_name": "JOSEPH",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "MSE., LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP0332",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "634050400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.