Individual provider Active NPI

Robert J Hoppe, PSYD, LP

  • Clinical Psychologist
  • St Louis Park, MN
National Provider Identifier
1417366832
Registry record updated Jan 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP 5758 Issued in MN
Practice address
4027 County Road 25
St Louis Park, MN 55416-2629
Phone
(612) 925-6033
Fax
(612) 925-8496
NPI assigned
Aug 11, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP 5758 MN Primary

Addresses

Primary practice location

4027 County Road 25
St Louis Park, MN 55416-2629

Mailing address

4240 Park Glen Rd
St Louis Park, MN 55416-5427
Phone (612) 925-6033

Other practice location 1

2817 Rock Merritt Ave Womack Army Medical Center
Fort Liberty, NC 28310-2629
Phone (910) 907-8922

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
I20170208001545 MN Practitioner - Clinical Psychologist 1456634906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Clinic of Psychology IncGroup PAC ID 0749171320, 136 clinicians

Practice addresses (Care Compare)

149 Thompson Ave E
Suite 150
West St Paul, MN 55118-3238
Phone (651) 450-0860

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP 5758MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Clinic of Psychology Inc CurrentSince Jan 9, 2017 Accepting new patients
Kente Circle Past Accepting new patients

Locations

4240 Park Glen Rd
St Louis Park, MN 55416
Phone (612) 925-6033

4027 County Road 25
St Louis Park, MN 55416
Phone (612) 925-6033

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736035200000",
    "number": "1417366832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165427",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 COUNTY ROAD 25",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162629",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2817 Rock Merritt Ave Womack Army Medical Center",
            "address_purpose": "LOCATION",
            "city": "Fort Liberty",
            "state": "NC",
            "postal_code": "283102629",
            "country_code": "US",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-8922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOPPE",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-11",
        "last_updated": "2025-01-05",
        "certification_date": "2025-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 5758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.