Jackie Engebretson, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP5917 Issued in MN

Practice address

7920 Old Cedar Ave S
Bloomington, MN 55425-1207

Phone

(952) 428-1800

NPI assigned

Sep 15, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.6 of 100Reported as group

Quality

72.5

Promoting interoperability

100

Improvement activities

40

Cost

77.07

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jengebretson591994@excellian.direct.allina.com

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.

• Allina Health System

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  Medicare reassignment NPD
• Allina Health System

  • Family Medicine Physician
  • Annandale, MN
  • NPI 1457657249
  Medicare reassignment NPD
• Allina Health System

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1134598667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7920 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251207",
            "telephone_number": "952-428-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3850 Park Nicollet Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554162527",
            "country_code": "US",
            "telephone_number": "952-993-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENGEBRETSON",
        "first_name": "JACKIE",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-15",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP5917",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Empower Living Services LLC
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• Margaret Delores Enebak
• McKenzie Enebo, BSN-RN, PHN
• David Allan Engan, D.D.S.
• Jennifer Lynn Engesether, D.C.
• Jon Brookson Engfer, MPS LADC CPRS
• Ava Elizabeth Engler
• Jill Marie Englund, PAC
• Alexandra Erickson, OTR/L

• Psychologist in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.