Active NPI
Michael Allen Scott, PSYD
- Psychologist
- Waconia, MN
National Provider Identifier
1194727552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP2561
- Practice address
- 540 E 1St St
Waconia, MN 55387-1601 - Phone
- (952) 442-4437
- Fax
- (952) 442-3084
- NPI assigned
- Aug 15, 2005
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP2561 | MN | Primary |
Addresses
Primary practice location
540 E 1St St
Waconia, MN 55387-1601
Mailing address
540 E 1St St
Waconia, MN 55387-1601
Phone (952) 442-4437
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44G78SC | Other | MN | BLUE CROSS BLUE SHIELD |
| HP 11407 | Other | MN | HEALTH PARTNERS |
| 0367054 | Other | MN | PREFERRED ONE |
| 115166 | Other | MN | U-CARE |
| 6167872 | Other | MN | UBH MEDICA |
| 678250700 | Medicaid | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2561 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392768000000",
"number": "1194727552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 E 1ST ST",
"city": "WACONIA",
"state": "MN",
"postal_code": "553871601",
"telephone_number": "952-442-4437",
"fax_number": "952-442-3084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 E 1ST ST",
"city": "WACONIA",
"state": "MN",
"postal_code": "553871601",
"telephone_number": "952-442-4437",
"fax_number": "952-442-3084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCOTT",
"first_name": "MICHAEL",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-15",
"last_updated": "2014-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP2561",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "44G78SC",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP 11407",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "0367054",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U-CARE",
"identifier": "115166",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH MEDICA",
"identifier": "6167872",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "678250700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.