Individual provider Active NPI

Bryon Jason Gallant, PSYD

  • Clinical Psychologist
  • Saint Cloud, MN
National Provider Identifier
1124676614
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP6718 Issued in MN
Practice address
1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone
(320) 229-4945
NPI assigned
Aug 28, 2019
Last updated
Oct 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP6718 MN Primary

Addresses

Primary practice location

1406 6TH Ave N
Saint Cloud, MN 56303-1900

Mailing address

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 229-4945

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211110003147 MN Practitioner - Clinical Psychologist 0345639431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians

Practice addresses (Care Compare)

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP6718MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Cloud Hospital Current Accepting new patients
St. Cloud Hospital CurrentSince Oct 12, 2021 Accepting new patients
St. Cloud Hospital CurrentSince Oct 12, 2021 Accepting new patients

Locations

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

1900 Centracare Cir
Ste 1000
Saint Cloud, MN 56303
Phone (320) 229-4945

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Interoperability endpoints

  • Direct secure messaging: bgallant524693@direct.centracare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1124676614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-229-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-229-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLANT",
        "first_name": "BRYON",
        "middle_name": "JASON",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-28",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.