Michelle L Purtle, PSYD LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

5628 Issued in MN

Practice address

540 E 1St St
Waconia, MN 55387-1600

Phone

(952) 442-4437

Fax

(952) 442-3084

NPI assigned

Aug 13, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle L Sexton Other name

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carver County 9 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 and National Provider Directory roles.

• Carver County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waconia, MN
  • NPI 1326049685

  MN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524700800000",
    "number": "1083846885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 E 1ST ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871600",
            "telephone_number": "952-442-4437",
            "fax_number": "952-442-3084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E 1ST ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871600",
            "telephone_number": "952-442-4437",
            "fax_number": "952-442-3084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6363 France Ave S",
            "address_2": "#200",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554352129",
            "country_code": "US",
            "telephone_number": "952-230-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PURTLE",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "PSYD LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-13",
        "last_updated": "2018-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "5628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "SEXTON",
            "middle_name": "L",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Elizabeth Anne Radke, PA-C
• Chezni Rang

• All providers in Waconia, MN
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.