Individual provider Active NPI

Jonathan Kirby, LMFT

  • Marriage & Family Therapist
  • New Brighton, MN
National Provider Identifier
1205235868
Registry record updated Aug 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2970 Issued in MN
Practice address
1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786
Phone
(651) 628-9566
NPI assigned
Aug 20, 2014
Last updated
Aug 20, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 2970 MN Primary

Addresses

Primary practice location

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786

Mailing address

1242 Berwick LN
Mahtomedi, MN 55115-2839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231229000610 MN Practitioner - Marriage and Family Therapist 4385094507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

1856 Beam Ave
Suite 200
Maplewood, MN 55109-1162
Phone (651) 661-6550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2970MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD Marriage & Family Therapist CurrentSince Jan 1, 2024 Accepting new patients
Family Support Services Inc. PastSince Jan 1, 2024 Accepting new patients

Locations

1856 Beam Ave
#200
Maplewood, MN 55109
Phone (651) 661-6550

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408492800000",
    "number": "1205235868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1242 BERWICK LN",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551152839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "address_2": "SUITE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRBY",
        "first_name": "JONATHAN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-20",
        "last_updated": "2014-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brighton, MN

Sources for this page

Verify at the official NPI Registry.