Individual provider Active NPI

Amanda Lane, PSYD

  • Psychologist
  • Moorhead, MN
National Provider Identifier
1336508274
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP5983 Issued in MN
Practice address
4000 28TH Ave S
Moorhead, MN 56560-7926
Phone
(701) 417-6999
NPI assigned
Feb 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP5983 MN Primary
Psychologist 103T00000X 541 ND

Addresses

Primary practice location

4000 28TH Ave S
Moorhead, MN 56560-7926

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

1301 8th St S
Moorhead, MN 56560-3604
Phone (701) 234-3100

Other practice location 2

400 E 1st St
Morris, MN 56267-1408
Phone (320) 589-1313

Other names 1

  • Amanda Jean Lane Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160407001320 MN Practitioner - Clinical Psychologist 1951609932 Reassigns benefits to 1 organization
I20180205001241 ND Practitioner - Clinical Psychologist 1951609932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

4000 28TH Ave S
Moorhead, MN 56560-7926
Phone (701) 234-3200

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
541NDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Jun 26, 2017 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jun 26, 2017 Accepting new patients

Locations

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

1301 8th St S
Moorhead, MN 56560
Phone (701) 234-3200

400 E 1st St
Morris, MN 56267
Phone (320) 589-1313

801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

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 and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1456012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1336508274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 28TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565607926",
            "telephone_number": "701-417-6999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 8th St S",
            "address_purpose": "LOCATION",
            "city": "Moorhead",
            "state": "MN",
            "postal_code": "565603604",
            "country_code": "US",
            "telephone_number": "701-234-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Morris",
            "state": "MN",
            "postal_code": "562671408",
            "country_code": "US",
            "telephone_number": "320-589-1313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANE",
        "first_name": "AMANDA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-21",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5983",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ND",
            "license": "541",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "LANE",
            "middle_name": "JEAN",
            "credential": "PSYD, LP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.