Active NPI
Geraldine Chavis, MA
- Psychologist
- Edina, MN
National Provider Identifier
1164570396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3463
- Practice address
- 4005 W 65TH St
Suite 108
Edina, MN 55435-1720 - Phone
- (952) 922-9090
- Fax
- (952) 929-0022
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3463 | MN | Primary |
Addresses
Primary practice location
4005 W 65TH St
Suite 108
Edina, MN 55435-1720
Mailing address
4005 W 65TH St
Suite 108
Edina, MN 55435-1720
Phone (952) 922-9090
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8B827CH | Other | MN | BLUE CROSS BLUE SHIELD |
| 01011769 | Other | MN | PREFERRED ONE |
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3463 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164570396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 W 65TH ST",
"address_2": "SUITE 108",
"city": "EDINA",
"state": "MN",
"postal_code": "554351720",
"telephone_number": "952-922-9090",
"fax_number": "952-929-0022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 W 65TH ST",
"address_2": "SUITE 108",
"city": "EDINA",
"state": "MN",
"postal_code": "554351720",
"telephone_number": "952-922-9090",
"fax_number": "952-929-0022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVIS",
"first_name": "GERALDINE",
"name_prefix": "Mrs.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3463",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8B827CH",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "01011769",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.