Individual provider Active NPI

Patrick Fischer Nusbaum

  • Professional Counselor
  • Saint Cloud, MN
National Provider Identifier
1093336364
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0023392 Issued in CO
Practice address
108 Doctors Park
Saint Cloud, MN 56303-1207
Phone
(320) 774-3915
Fax
(320) 774-3918
NPI assigned
Apr 28, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0023392 CO Primary
Professional Counselor 101YP2500X 5064 MN

Addresses

Primary practice location

108 Doctors Park
Saint Cloud, MN 56303-1207

Mailing address

108 Doctors Park
Saint Cloud, MN 56303-1207
Phone (320) 774-3915

Other practice location 1

205 14th Ave E
Sartell, MN 56377-4500
Phone (320) 774-3436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northway Academy, Inc. Past Accepting new patients
Northway Academy, Inc. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1093336364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 DOCTORS PARK",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031207",
            "telephone_number": "320-774-3915",
            "fax_number": "320-774-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 DOCTORS PARK",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031207",
            "telephone_number": "320-774-3915",
            "fax_number": "320-774-3918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 14th Ave E",
            "address_purpose": "LOCATION",
            "city": "Sartell",
            "state": "MN",
            "postal_code": "563774500",
            "country_code": "US",
            "telephone_number": "320-774-3436",
            "fax_number": "320-774-3440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUSBAUM",
        "first_name": "PATRICK",
        "middle_name": "FISCHER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-28",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "0023392",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "5064",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.