NPIMap

Organization Active NPI

Autism Society of Minnesota

  • Psychologist
  • Saint Paul, MN
National Provider Identifier
1447236609
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
AUTISM SOCIETY OF MINNESOTA
Practice address
2380 Wycliff St
Suite 102
Saint Paul, MN 55114-1279
Phone
(651) 647-1083
NPI assigned
Dec 20, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dawn Brasch
Title
Director
Phone
(651) 647-1083

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

2380 Wycliff St
Suite 102
Saint Paul, MN 55114-1279

Mailing address

2380 Wycliff St
Suite 102
Saint Paul, MN 55114-1279
Phone (651) 647-1083

Other identifiers 1

IdentifierTypeStateIssuer
323J8AUOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000474 MN Part B Supplier - Clinic/Group Practice 8224921242 Receives reassigned benefits from 7 practitioners
Practice locations: Saint Paul, MN

National Provider Directory

National Provider Directory

Locations

2380 Wycliff St
Ste 102
Saint Paul, MN 55114
Phone 6516471083 ext. 17

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1447236609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 WYCLIFF ST",
            "address_2": "SUITE 102",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141279",
            "telephone_number": "651-647-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 WYCLIFF ST",
            "address_2": "SUITE 102",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141279",
            "telephone_number": "651-647-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM SOCIETY OF MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2022-07-21",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "BRASCH",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "651-647-1083"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "323J8AU",
            "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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.