NPIMap

Individual provider Active NPI

Jacob Robert Tjaden, D.O.

  • Psychiatry Physician
  • Saint Cloud, MN
National Provider Identifier
1164688479
Registry record updated Mar 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
51453 Issued in MN
Practice address
1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303
Phone
(320) 251-2700
Fax
(320) 229-5109
NPI assigned
Aug 6, 2008
Last updated
Mar 18, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 51453 MN Primary

Addresses

Primary practice location

1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303

Mailing address

1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303
Phone (320) 251-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090427000239 MN Practitioner - Psychiatry 5193873453 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

PO Box
Minneapolis, MN 55440-0043

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Oct 10, 2018 Accepting new patients
Allina Health System CurrentSince Sep 24, 2012 Accepting new patients
St. Cloud Hospital CurrentSince May 1, 2009 Accepting new patients
Centracare Health System-NR LLC CurrentSince Oct 10, 2018 Accepting new patients
Allina Health System Current Accepting new patients
St Cloud Pathologists PA Current Accepting new patients
Regional Diagnostic Radiology Current Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Allina Health System CurrentSince Sep 24, 2012 Accepting new patients
Allina Health System Past Accepting new patients

Locations

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

Interoperability endpoints

  • Direct secure messaging: jtjaden11753@direct.centracare.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237334400000",
    "number": "1164688479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVENUE NORTH",
            "address_2": "ST. CLOUD HOSPITAL",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-251-2700",
            "fax_number": "320-229-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVENUE NORTH",
            "address_2": "ST. CLOUD HOSPITAL",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-251-2700",
            "fax_number": "320-229-5109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TJADEN",
        "first_name": "JACOB",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-06",
        "last_updated": "2009-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "51453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.