Individual provider Active NPI

Richelle N Moen, PHD

  • Psychologist
  • Minneapolis, MN
National Provider Identifier
1366514242
Registry record updated Feb 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP2440 Issued in MN
Practice address
University of Minnesota Physicians
2312 South 6TH Street, Suite F256, 2B W
Minneapolis, MN 55454
Phone
(612) 273-8700
NPI assigned
Nov 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP2440 MN Primary
Marriage & Family Therapist 106H00000X LP2440 MN

Addresses

Primary practice location

University of Minnesota Physicians
2312 South 6TH Street, Suite F256, 2B W
Minneapolis, MN 55454

Mailing address

University of Minnesota Physicians
2312 South 6TH Street, Suite F256, 2B W
Minneapolis, MN 55454
Phone (612) 273-8700

Other identifiers 9

IdentifierTypeStateIssuer
1012203OtherPREFERRED ONE
8D932MOOtherBLUE CROSS BLUE SHIELD
922250200MedicaidMN
17886MedicaidND
HP28967OtherHEALTH PARTNERS
106588OtherUCARE
61-30122OtherMEDICA CHOICE
61-30122OtherMEDICA PRIMARY
768274OtherARAZ

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101006000629 MN Practitioner - Clinical Psychologist 0941492136 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (855) 324-7843

2450 Riverside Ave
Minneapolis, MN 55454-1450

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

Hospital & facility affiliations

  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP2440MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
University of Minnesota Physicians CurrentSince Jan 1, 1998 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Jan 1, 2019 Accepting new patients
Fairview Express Care Current Accepting new patients

Locations

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

2312 S 6th St
Ste F256
Minneapolis, MN 55454
Phone (612) 273-8700

2450 Riverside Ave
Fl 2A
Minneapolis, MN 55454

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

Organizations & group practices 6

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 3

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329177600000",
    "number": "1366514242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF MINNESOTA PHYSICIANS",
            "address_2": "2312 SOUTH 6TH STREET, SUITE F256, 2B W",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55454",
            "telephone_number": "612-273-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF MINNESOTA PHYSICIANS",
            "address_2": "2312 SOUTH 6TH STREET, SUITE F256, 2B W",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55454",
            "telephone_number": "612-273-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "RICHELLE",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2012-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2440",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "LP2440",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1012203",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8D932MO",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "922250200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17886",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP28967",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "106588",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "61-30122",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "61-30122",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "768274",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.