Active NPI
John Michael Imp, PHD., L.P.
- Clinical Psychologist
- Rochester, MN
National Provider Identifier
1164559241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP2523
- Practice address
- 300 3Rd Ave SE
Suite 405
Rochester, MN 55904-4619 - Phone
- (507) 288-8544
- Fax
- (507) 288-8545
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP2523 | MN | Primary |
Addresses
Primary practice location
300 3Rd Ave SE
Suite 405
Rochester, MN 55904-4619
Mailing address
1357 Windbreak CT NE
Rochester, MN 55906-8587
Phone (507) 289-5409
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HP38677 | Other | MN | HEALTHPARTNERS |
| 921001033636 | Other | MN | PREFERRED ONE |
| 143305 | Other | MN | UCARE |
| 362J3IM | Other | MN | BCBS OF MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2523 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associates in Psychiatry and Psychology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Group Psychotherapy Psychologist
- Rochester, MN
- NPI 1922145622
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1164559241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1357 WINDBREAK CT NE",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559068587",
"telephone_number": "507-289-5409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 3RD AVE SE",
"address_2": "SUITE 405",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559044619",
"telephone_number": "507-288-8544",
"fax_number": "507-288-8545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMP",
"first_name": "JOHN",
"middle_name": "MICHAEL",
"credential": "PHD., L.P.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP2523",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP38677",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "921001033636",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "143305",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MN",
"identifier": "362J3IM",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.