NPIMap

Organization Active NPI

Premier Sport Psychology, PLLC

  • Psychologist
  • Edina, MN
National Provider Identifier
1104779586
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
PREMIER SPORT PSYCHOLOGY, PLLC
Practice address
7401 Metro Blvd Ste 510
Edina, MN 55439-3033
Phone
(952) 835-8513
NPI assigned
Feb 17, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Authorized official

Name
Chadric Rasmussen
Title
Director of Finance & Operations
Phone
(952) 456-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

7401 Metro Blvd Ste 510
Edina, MN 55439-3033

Mailing address

7401 Metro Blvd Ste 510
Edina, MN 55439-3033
Phone (952) 835-8513

National Provider Directory

National Provider Directory

Locations

7401 Metro Blvd
Ste 510
Minneapolis, MN 55439
Phone (952) 835-8513

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1771286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771286400000",
    "number": "1104779586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 METRO BLVD STE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554393033",
            "telephone_number": "952-835-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 METRO BLVD STE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554393033",
            "telephone_number": "952-835-8513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SPORT PSYCHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-17",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A",
        "authorized_official_last_name": "RASMUSSEN",
        "authorized_official_first_name": "CHADRIC",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE & OPERATIONS",
        "authorized_official_telephone_number": "952-456-2910"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.