Active NPI
Lifetrack Resources, Inc.
- Clinical Child & Adolescent Psychologist
- Saint Paul, MN
National Provider Identifier
1225045362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Legal business name
- LIFETRACK RESOURCES, INC.
- Practice address
- 709 University Ave W
Saint Paul, MN 55104-4804 - Phone
- (651) 227-8471
- Fax
- (651) 265-2318
- NPI assigned
- Aug 2, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Trixie Ann Golberg
- Title
- President
- Phone
- (651) 227-8471
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary | ||
| Clinical Social Worker | 1041C0700X | |||
| Occupational Therapy Assistant | 224Z00000X | |||
| Physical Therapist | 225100000X | |||
| Pediatric Physical Therapist | 2251P0200X | |||
| Physical Therapy Assistant | 225200000X | |||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
709 University Ave W
Saint Paul, MN 55104-4804
Mailing address
709 University Ave W
Saint Paul, MN 55104-4804
Phone (651) 227-8471
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1019353 | Other | MN | PREFERRED ONE |
| 119905 | Other | MN | CHOICE PLUS |
| 13112SP | Other | MN | BCBS - OT |
| 995555101 | Medicaid | MN | |
| 27779PA | Other | MN | BCBS - PT |
| 5900058 | Other | MN | MEDICA DUAL SOLUTION |
| 553476300 | Medicaid | MN | |
| 431M9LI | Other | MN | BCBS - MENTAL HEALTH |
| 995555100 | Medicaid | MN | |
| 102486 | Other | MN | UCARE - PT/OT/SP |
| 108931 | Other | MN | UCARE - MENTAL HEALTH |
| 505120046 | Other | MN | MHP |
| 28605PA | Other | MN | BCBS - SP |
| 6400054 | Other | MN | MEDICA CROSS OVER MEDICAR |
Other names 1
- St. Paul Rehabilitation Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Outpatient physical therapy / speech pathology certification: CCN 246504
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- LIFETRACK RESOURCES
- Certification status
- Active
- Provider type (POS)
- Outpatient physical therapy / speech pathology
- Participating since
- Oct 9, 1968
- Last certification
- Jan 28, 2014
- Ownership / control type
- VOLUNTARY NON PROFIT OTHER THAN CHURCH
- Facility address
- 709 University Avenue West
Saint Paul, MN 55104
National Provider Directory
National Provider DirectoryLocations
709 University Ave W
Saint Paul, MN 55104
Phone (651) 227-8471
Practitioners & affiliated clinicians
Practitioners 38
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1316370943
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1710006895
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1871612028
-
- Occupational Therapist
- Saint Paul, MN
- NPI 1679691067
-
- Clinical Social Worker
- Saint Paul, MN
- NPI 1164696928
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1235365412
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1215055660
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1568636900
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1700143781
-
- Occupational Therapist
- Saint Paul, MN
- NPI 1376661751
-
- Speech-Language Pathologist
- Saint Paul, MN
- NPI 1063531226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1369872000000",
"number": "1225045362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044804",
"telephone_number": "651-227-8471",
"fax_number": "651-265-2318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044804",
"telephone_number": "651-227-8471",
"fax_number": "651-265-2318"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIFETRACK RESOURCES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-02",
"last_updated": "2013-05-30",
"status": "A",
"authorized_official_last_name": "GOLBERG",
"authorized_official_first_name": "TRIXIE",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "651-227-8471"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist, Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1019353",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHOICE PLUS",
"identifier": "119905",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - OT",
"identifier": "13112SP",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "995555101",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - PT",
"identifier": "27779PA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA DUAL SOLUTION",
"identifier": "5900058",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "553476300",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - MENTAL HEALTH",
"identifier": "431M9LI",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "995555100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE - PT/OT/SP",
"identifier": "102486",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE - MENTAL HEALTH",
"identifier": "108931",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHP",
"identifier": "505120046",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - SP",
"identifier": "28605PA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CROSS OVER MEDICAR",
"identifier": "6400054",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "St. Paul Rehabilitation Center",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.