Ryan Michael Engdahl, PHD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP5519 Issued in MN

Practice address

1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303-1901

Phone

(320) 251-2700

Fax

(320) 229-5109

NPI assigned

May 9, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Cloud, MN
  • NPI 1043212665
  Medicare reassignment NPD
• St. Cloud Hospital

  • General Acute Care Hospital
  • Saint Cloud, MN
  • NPI 1043269798
  Medicare reassignment
• Centracare Clinic

  • Primary Care Clinic/Center
  • St Cloud, MN
  • NPI 1659425114
  NPD
• St. Cloud Hospital

  • Clinic/Center
  • St Cloud, MN
  • NPI 1770532426
  NPD
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Joseph, MN
  • NPI 1134121759
  NPD (past)
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1225030844
  NPD (past)

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

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1407148588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRA CARE CIRCLE #2475",
            "address_2": "CENTRA CARE HEALTH PLAZA",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-5199",
            "fax_number": "320-229-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVENUE NORTH",
            "address_2": "ST. CLOUD HOSPITAL",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "563031901",
            "telephone_number": "320-251-2700",
            "fax_number": "320-229-5109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGDAHL",
        "first_name": "RYAN",
        "middle_name": "MICHAEL",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-09",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Empathic Home Health Care LLC
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• Endodontic Professionals PA St Cloud Endodontics
• Sarah Elizabeth Enga, PT
• Carrie Ann Engdahl, PHARM.D.
• Amy Lynne Engelhart, PHARM.D.
• Brian Engelman, PHARMD
• Mark Engelsgjerd, M.D.
• Alexander England
• Gina Marie Engle

• Clinical Psychologist in St. Cloud, MN
• Providers in St. Cloud, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.