Active NPI
Jane Ann Bennett, LP
- Psychologist
- Minneapolis, MN
National Provider Identifier
1366553877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 4151
- Practice address
- 314 Clifton Ave Ste 201
Minneapolis, MN 55403-3385 - Phone
- (612) 750-7219
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4151 | MN | Primary |
Addresses
Primary practice location
314 Clifton Ave Ste 201
Minneapolis, MN 55403-3385
Mailing address
314 Clifton Ave Ste 201
Minneapolis, MN 55403-3385
Phone (612) 750-7219
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 474128500 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2019 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4151 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563926400000",
"number": "1366553877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 CLIFTON AVE STE 201",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554033385",
"telephone_number": "612-750-7219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 CLIFTON AVE STE 201",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554033385",
"telephone_number": "612-750-7219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "JANE",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2019-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "4151",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "474128500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.