Jan Tyson Roberts, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5330 Issued in MN

Practice address

5353 Gamble Dr Ste 395
St Louis Park, MN 55416-1510

Phone

(612) 367-7103

Fax

(952) 925-5972

NPI assigned

May 5, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Aspen Psychological Consulting, LLC

  • Adult Mental Health Clinic/Center
  • St Louis Park, MN
  • NPI 1326486507
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1304553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1265724561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5353 GAMBLE DR STE 395",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161510",
            "telephone_number": "612-367-7103",
            "fax_number": "952-925-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 GAMBLE DR STE 395",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161510",
            "telephone_number": "612-367-7103",
            "fax_number": "952-925-5972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON ROBERTS",
        "first_name": "JAN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-05",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "5330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Twiford
• Twin Cities Lighthouse Therapy, LLC
• Twin Cities Periodontics
• Twin Cities TMJ & Facial Pain Clinic, LTD.
• Mary Ann Tyler
• Michelle A Ugalde, PT-DPT
• Katharine Anna Uganski, DO
• Mackenzie Lynn Uhlenhopp
• Adam James Uithoven, PA-C
• Ken Ujifusa, PSY.D.

• Clinical Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; 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.