Craig Jon Vine, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

33712 Issued in MN

Practice address

2550 University Avenue West
Suite 229N
St Paul, MN 55114

Phone

(651) 645-3115

Fax

(651) 645-2752

NPI assigned

Jan 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of Iowa, RJ & L Carver College of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Psych Recovery IncGroup PAC ID 3779633912, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Psych Recovery Inc

  • Psychiatry Physician
  • Saint Paul, MN
  • NPI 1316189541
  Medicare reassignment Care Compare group NPD
• Psychiatric Recovery PA

  • Adolescent and Children Mental Health Clinic/Center
  • Saint Paul, MN
  • NPI 1891713681
  NPD (past)

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360454400000",
    "number": "1164400495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVENUE WEST",
            "address_2": "SUITE 229N",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55114",
            "telephone_number": "651-645-3115",
            "fax_number": "651-645-2752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVENUE WEST",
            "address_2": "SUITE 229N",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55114",
            "telephone_number": "651-645-3115",
            "fax_number": "651-645-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINE",
        "first_name": "CRAIG",
        "middle_name": "JON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2013-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "33712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "317T6VI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1530494",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "786505800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Villas at St Paul LLC
• Frank Eugene Villaume IV, M.D.
• Lourdes Gomez Villaume, MD
• Alberto Isaac Villegas Licona, D.C.
• Rochelle Vincent
• Melanie M.P. Vinton, LMFT
• Kailee Lynne Violett, RN, BSN
• Vip Family Chiropractic L.L.C.
• Virta Therapy Collective LLC
• Virtue Healthcare Solutions LLC

• Psychiatry Physician in St Paul, MN
• Providers in St Paul, MN by specialty
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2013; 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.