David Carroll, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2633 Issued in MN

Practice address

1751 Tower Dr W Ste 200
Stillwater, MN 55082-7596

Phone

(651) 439-2059

Fax

(888) 675-8262

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Group practices

Rush IncGroup PAC ID 8224131750, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Rush Inc

  • Psychologist
  • Stillwater, MN
  • NPI 1801942040
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1205913290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "588 101ST AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341083201",
            "telephone_number": "651-439-2059",
            "fax_number": "888-675-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 TOWER DR W STE 200",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827596",
            "telephone_number": "651-439-2059",
            "fax_number": "888-675-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "DAVID",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "2633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205913290",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgina Lenore Dixon Carlson, MD
• Glenna Ruth Carlson
• Harmony Ann Carlson, PSY.D., LP
• Sarah L Carlson, D.D.S.
• Wayne Donald Carlson, MD
• Rebecca Lynn Carruthers, PT
• James Philip Caruso, M.D.
• Loren Leroy Carver
• Michael Casale
• Ann D Casanova, DPT

• Clinical Psychologist in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.