Individual provider Active NPI

Peter James Hartwich, MS, LMFT

  • Marriage & Family Therapist
  • Coon Rapids, MN
National Provider Identifier
1497811780
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
832 Issued in MN
Practice address
1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708
Phone
(651) 774-0011
Fax
(651) 774-0606
NPI assigned
Dec 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 832 MN Primary

Addresses

Primary practice location

1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708

Mailing address

3000 Ames Crossing Rd Ste 600
Eagan, MN 55121-2519
Phone (651) 774-0011

Other identifiers 1

IdentifierTypeStateIssuer
692725400MedicaidMN

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
I20240110002654 MN Practitioner - Marriage and Family Therapist 2860843265 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
832MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
People Incorporated CurrentSince Jan 1, 2024 Accepting new patients
People Incorporated Current Accepting new patients
The Family Partnership Past Accepting new patients

Locations

1930 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 427-7964

2120 Park Ave
Minneapolis, MN 55404
Phone (612) 872-2000

5555 Boone Ave N
New Hope, MN 55428
Phone (763) 331-3033

3000 Ames Crossing Rd
Ste 600
Saint Paul, MN 55121
Phone (651) 288-3467

317 York Ave
Saint Paul, MN 55130
Phone (651) 771-0286

Organizations & group practices 3

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1497811780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 AMES CROSSING RD STE 600",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551212519",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTWICH",
        "first_name": "PETER",
        "middle_name": "JAMES",
        "credential": "MS, LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "692725400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.