Active NPI
John Nolen O'Neil, PH.D.
- Clinical Psychologist
- Edina, MN
National Provider Identifier
1124164553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4307
- Practice address
- 7101 York Ave S Ste 301
Edina, MN 55435-4469 - Phone
- (612) 223-7103
- Fax
- (952) 681-2792
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4307 | MN | Primary |
Addresses
Primary practice location
7101 York Ave S Ste 301
Edina, MN 55435-4469
Mailing address
7101 York Ave S Ste 301
Edina, MN 55435-4469
Phone (612) 223-7103
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HP40630 | Other | MN | HEALTH PARTNERS |
| 013764200 | Medicaid | MN | |
| 6169449 | Other | MEDICA | |
| 169041 | Other | MN | UCARE |
| 49F690N | Other | MN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4307 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577232000000",
"number": "1124164553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7101 YORK AVE S STE 301",
"city": "EDINA",
"state": "MN",
"postal_code": "554354469",
"telephone_number": "612-223-7103",
"fax_number": "952-681-2792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7101 YORK AVE S STE 301",
"city": "EDINA",
"state": "MN",
"postal_code": "554354469",
"telephone_number": "612-223-7103",
"fax_number": "952-681-2792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'NEIL",
"first_name": "JOHN",
"middle_name": "NOLEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2019-12-25",
"certification_date": "2019-12-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4307",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP40630",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "013764200",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6169449",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "169041",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "49F690N",
"state": "MN"
}
],
"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 Dec 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.