NPIMap

Organization Active NPI

Optum Behavioral Care of Colorado, P.C.

Doing business as Northern Psychiatric Associates of Minnesota

  • Clinical Psychologist
  • Baxter, MN
National Provider Identifier
1124898556
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Doing business as
Northern Psychiatric Associates of Minnesota
Practice address
7115 Forthun Rd Ste 105
Baxter, MN 56425-8598
Phone
(704) 506-6267
NPI assigned
Jan 5, 2024
Last updated
Aug 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

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

Authorized official

Name
Amanda Stacey BronsonNPI 1043591167
Title
Dir Gen MGMT
Phone
(978) 222-3121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

7115 Forthun Rd Ste 105
Baxter, MN 56425-8598

Mailing address

11000 Optum Cir
Eden Prairie, MN 55344-2503
Phone (704) 506-6267

Other names 1

  • Northern Psychiatric Associates of Minnesota Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240725003342 MN Part B Supplier - Clinic/Group Practice 0941648463 Receives reassigned benefits from 107 practitioners
3 other NPIs on this enrollment
Practice locations: Maple Grove, MN; Saint Louis Park, MN; Plymouth, MN; Minneapolis, MN; Mendota Heights, MN; Mankato, MN; Lake Elmo, MN; Edina, MN…

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Optum Behavioral PC33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Locations

3601 Minnesota Dr
Ste 575
Minneapolis, MN 55435
Phone (612) 799-8975

Practitioners & affiliated clinicians

Practitioners 123

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786060800000",
    "number": "1124898556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 OPTUM CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442503",
            "telephone_number": "704-506-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7115 FORTHUN RD STE 105",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258598",
            "telephone_number": "704-506-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-05",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A",
        "authorized_official_last_name": "BRONSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "STACEY",
        "authorized_official_title_or_position": "DIR GEN MGMT",
        "authorized_official_telephone_number": "978-222-3121"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Psychiatric Associates of Minnesota",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; 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.