David Gene Brunetti, PHD – Clinical Psychologist

Key facts

NPI: 1447584735
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Psychologist 103TC0700X
License: LP4170 (MN)
Practice address: 21308 John Milless Dr
Suite 101B
Rogers, MN 55374-4708
Phone: (763) 428-4060
Fax: (763) 428-1711
NPI assigned: Sep 20, 2009
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Brunetti Consulting, Inc Clinical Neuropsychologist · Rogers, MN · NPI 1982719118

Medicare reassignment Care Compare group NPD CLINICAL · MN

Medicare Care Compare profile

Specialty: Clinical Psychologist
Education: Other, 1994
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Brunetti Consulting, Inc (2 clinicians)

Practice addresses (Care Compare)

21308 John Milless Dr
Suite 101B
Rogers, MN 55374-4875
Phone (763) 428-4060

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MN
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20091217000660	MN	Practitioner - Clinical Psychologist	7214947761	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
LP4170	MN	MD	Clinical Psychologist

Practice roles

Organization	Specialty	Status	New patients
Brunetti Consulting, Inc	Clinical	Current since Mar 2, 2006	Accepting new patients

Locations

21308 John Milless Dr
Ste 101B
Rogers, MN 55374
Phone (763) 428-4060

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Psychologist	103TC0700X	LP4170	MN	Yes

Addresses

Primary practice location

21308 John Milless Dr
Suite 101B
Rogers, MN 55374-4708

Mailing address

21308 John Milless Dr
Suite 101B
Rogers, MN 55374-4708
Phone (763) 428-4060

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2009.

{
    "created_epoch": "1253404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253404800000",
    "number": "1447584735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21308 JOHN MILLESS DR",
            "address_2": "SUITE 101B",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744708",
            "telephone_number": "763-428-4060",
            "fax_number": "763-428-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21308 JOHN MILLESS DR",
            "address_2": "SUITE 101B",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744708",
            "telephone_number": "763-428-4060",
            "fax_number": "763-428-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNETTI",
        "first_name": "DAVID",
        "middle_name": "GENE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-20",
        "last_updated": "2009-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, MN

All providers in Rogers, MN · Clinical Psychologist in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.