Active NPI
David P Lommen, PH.D.
- Clinical Psychologist
- Grand Forks, ND
National Provider Identifier
1356375646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 211
- Practice address
- 2808 17TH Ave S
Grand Forks, ND 58201-4010 - Phone
- (701) 746-8376
- Fax
- (701) 746-9872
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 211 | ND | Primary |
Addresses
Primary practice location
2808 17TH Ave S
Grand Forks, ND 58201-4010
Mailing address
649 Barley CT
Grand Forks, ND 58201-8067
Phone (701) 330-2376
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16927 | Medicaid | ND | |
| 560352800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 211 | ND | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Anne'S Guest Home | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Custodial Care Facility
- Grand Forks, ND
- NPI 1518373224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552348800000",
"number": "1356375646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "649 BARLEY CT",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582018067",
"telephone_number": "701-330-2376",
"fax_number": "701-335-7346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2808 17TH AVE S",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014010",
"telephone_number": "701-746-8376",
"fax_number": "701-746-9872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOMMEN",
"first_name": "DAVID",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2019-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ND",
"license": "211",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "16927",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "560352800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.