Amy Moran Wheelecor, PSYD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP6437 Issued in MN

Practice address

10729 Town Square Dr NE Ste 120
Blaine, MN 55449-7923

Phone

(763) 343-9010

NPI assigned

Sep 11, 2019

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 names 1

• Amy Catherine Moran Former name

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, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Susan Borden PsychGroup PAC ID 4688011612, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Susan Borden Psych

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Paul, MN
  • NPI 1780313478

  Psychologist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1164071148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10729 TOWN SQUARE DR NE STE 120",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554497923",
            "telephone_number": "763-343-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10729 TOWN SQUARE DR NE STE 120",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554497923",
            "telephone_number": "763-343-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELECOR",
        "first_name": "AMY",
        "middle_name": "MORAN",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-11",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "MORAN",
            "middle_name": "CATHERINE",
            "credential": "PSYD, LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.