Anastasia Sullwold Ristau, PHD LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4538 Issued in MN

Practice address

111 Hundertmark Rd Ste 205N
Chaska, MN 55318-1586

Phone

(952) 903-1350

Fax

(952) 426-3856

NPI assigned

Jul 21, 2006

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 identifiers 1

Other names 1

• Dr. Anastasia C Sullwold Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EFDABA

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.

• Minnesota Epilepsy Group PA

  • Neurology Physician
  • Roseville, MN
  • NPI 1932118056
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1124049903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 ZANE AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431814",
            "telephone_number": "763-762-8800",
            "fax_number": "763-315-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HUNDERTMARK RD STE 205N",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181586",
            "telephone_number": "952-903-1350",
            "fax_number": "952-426-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISTAU",
        "first_name": "ANASTASIA",
        "middle_name": "SULLWOLD",
        "name_prefix": "Dr.",
        "credential": "PHD  LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "949674200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANASTASIA",
            "last_name": "SULLWOLD",
            "middle_name": "C",
            "prefix": "DR.",
            "credential": "PHD LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Alexis Rivard, BA
• Erin Roberts
• Margaret Roberts, LMFT
• Melanie Rodgers
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• Psychologist in Chaska, MN
• Providers in Chaska, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; 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.