Individual provider Active NPI

Elliott V. Troup Jr., M.ED. L.P.

  • Psychologist
  • Minneapolis, MN
National Provider Identifier
1104813716
Registry record updated Apr 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP3059 Issued in MN
Practice address
431 S 7TH St
#2402
Minneapolis, MN 55415-1821
Phone
(612) 708-4242
Fax
(952) 831-0530
NPI assigned
Sep 29, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP3059 MN Primary

Addresses

Primary practice location

431 S 7TH St
#2402
Minneapolis, MN 55415-1821

Mailing address

431 S 7TH St
#2402
Minneapolis, MN 55415-1821
Phone (612) 708-4242

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171228001098 MN Practitioner - Psychologist Billing Independently 8325306129 Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Engineering, Master of Education

State licenses

LicenseStateTypeSpecialty
LP3059MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
David L. Johnson, MD, LTD PastSince Dec 1, 2020 Accepting new patients

Organizations & group practices 1

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271808000000",
    "number": "1104813716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 S 7TH ST",
            "address_2": "#2402",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151821",
            "telephone_number": "612-708-4242",
            "fax_number": "952-831-0530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 S 7TH ST",
            "address_2": "#2402",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151821",
            "telephone_number": "612-708-4242",
            "fax_number": "952-831-0530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TROUP",
        "first_name": "ELLIOTT",
        "middle_name": "V.",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.ED. L.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2010-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.