Active NPI
Michael H Miner, PHD
- Clinical Psychologist
- Minneapolis, MN
National Provider Identifier
1487739827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP1169
- Practice address
- 1300 S 2ND St
Suite 180
Minneapolis, MN 55454-1075 - Phone
- (612) 625-1500
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP1169 | MN | |
| Clinical Psychologist | 103TC0700X | LP1169 | MN | Primary |
Addresses
Primary practice location
1300 S 2ND St
Suite 180
Minneapolis, MN 55454-1075
Mailing address
3989 Central Ave NE
Suite 300
Columbia Heights, MN 55421-3900
Phone (612) 625-1500
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 704020200 | Medicaid | MN | |
| HP27165 | Other | MN | HEALTH PARTNERS |
| 1007674 | Other | MN | PREFERRED ONE |
| 61-90177 | Other | MN | MEDICA CHOICE |
| 102454 | Other | MN | UCARE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1169 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215388800000",
"number": "1487739827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3989 CENTRAL AVE NE",
"address_2": "SUITE 300",
"city": "COLUMBIA HEIGHTS",
"state": "MN",
"postal_code": "554213900",
"telephone_number": "612-625-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 S 2ND ST",
"address_2": "SUITE 180",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541075",
"telephone_number": "612-625-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINER",
"first_name": "MICHAEL",
"middle_name": "H",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2008-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP1169",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP1169",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "704020200",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP27165",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1007674",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CHOICE",
"identifier": "61-90177",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "102454",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.