Mark B Weisberg, PH.D., ABPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP 1311 Issued in MN

Practice address

430 Oak Grove St
Suite 407
Minneapolis, MN 55403-3253

Phone

(612) 520-9159

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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.

Opted out of Medicare

Yes, effective Jul 1, 2010 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Center for Psychological Consultation, P.a.

  • Clinical Psychologist
  • Golden Valley, MN
  • NPI 1407123425
  NPD (past)
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • St Paul, MN
  • NPI 1104850155
  NPD (past)
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • Burnsville, MN
  • NPI 1255715181
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104936913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 OAK GROVE ST",
            "address_2": "SUITE 407",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033253",
            "telephone_number": "612-520-9159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 OAK GROVE ST",
            "address_2": "SUITE 407",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033253",
            "telephone_number": "612-520-9159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISBERG",
        "first_name": "MARK",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "PH.D., ABPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 1311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Alexander Weinreich, M.D.
• Edward Kenneth Weir, MD
• Andrew Weis, APRN, CRNA
• John R Weis, MD
• Melinda Ann Weis, RD, LD
• Daniel J Weisdorf, MD
• Brynn E Weise, MD
• Karlie Jo Weishoff, LICSW
• Susan Alise Weislow
• Anne Laure Weiss, MD

• Clinical Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.