Individual provider Active NPI

Joseph James Bauer, MSE., LP

  • Psychologist
  • Stillwater, MN
National Provider Identifier
1083717433
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP0332 Issued in MN
Practice address
11010 Pawnee Ave N
Stillwater, MN 55082-9592
Phone
(612) 817-5487
NPI assigned
Sep 7, 2006
Last updated
Mar 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
634050400MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

LicenseStateTypeSpecialty
LP0332MNMDPsychologist

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.

Verify at the official NPI Registry.