Individual provider Active NPI

Kevin J Rooney, PSYD

  • Psychologist
  • La Crosse, WI
National Provider Identifier
1215910310
Registry record updated Apr 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2272 Issued in WI
Practice address
212 11TH St S
La Crosse, WI 54601-4116
Phone
(608) 791-9555
Fax
(608) 791-9432
NPI assigned
Nov 22, 2005
Last updated
Apr 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2272 WI Primary

Addresses

Primary practice location

212 11TH St S
La Crosse, WI 54601-4116

Mailing address

212 11TH St S
La Crosse, WI 54601-4116
Phone (608) 791-9555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050113000432 WI Practitioner - Clinical Psychologist 9436108735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3703 Oakwood Hills Pkwy
Suite 100
Eau Claire, WI 54701-4458
Phone (534) 444-4562

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2272WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates Counseling Wi., S.C. CurrentSince Apr 1, 2024 Accepting new patients
Nystrom & Associates Counseling Wi., S.C. CurrentSince Apr 1, 2024 Accepting new patients

Locations

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

2005 Highland Ave
Ste B
Eau Claire, WI 54701
Phone (866) 559-3060

3703 Oakwood Hills Pkwy
Ste 100
Eau Claire, WI 54701
Phone (534) 444-4562

201 Main St
Ste 500
La Crosse, WI 54601
Phone (608) 668-4005

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": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365120000000",
    "number": "1215910310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 11TH ST S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014116",
            "telephone_number": "608-791-9555",
            "fax_number": "608-791-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 11TH ST S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014116",
            "telephone_number": "608-791-9555",
            "fax_number": "608-791-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROONEY",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2013-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.