Active NPI
Jay Thomas Gourlie
- Psychologist
- Saint Paul, MN
National Provider Identifier
1407877277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 2221 Ford Pkwy
Saint Paul, MN 55116-1800 - Phone
- (651) 645-2227
- NPI assigned
- Jul 21, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
2221 Ford Pkwy
Saint Paul, MN 55116-1800
Mailing address
PO Box 1239
Brainerd, MN 56401-9600
Phone (651) 645-2227
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 69260GO | Other | MN | BCBS |
| 6107401 | Other | MN | UBH MEDICA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199750400000",
"number": "1407877277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1239",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564019600",
"telephone_number": "651-645-2227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2221 FORD PKWY",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551161800",
"telephone_number": "651-645-2227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOURLIE",
"first_name": "JAY",
"middle_name": "THOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2008-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "69260GO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH MEDICA",
"identifier": "6107401",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.