Active NPI
Charles Orsak, LP, PHD
- Psychologist
- Duluth, MN
National Provider Identifier
1508966730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3196
- Practice address
- 510 W Quince St
Duluth, MN 55811-3338 - Phone
- (218) 724-3472
- NPI assigned
- Sep 25, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3196 | MN | Primary |
Addresses
Primary practice location
510 W Quince St
Duluth, MN 55811-3338
Mailing address
400 East 3Rd Street
Duluth, MN 55805
Phone (218) 766-8364
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 718213900 | Medicaid | MN |
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 |
|---|---|---|---|
| LP3196 | MN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwood Children'S Home Society Inc | Psychologist | Past | Accepting new patients |
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Duluth, MN
- NPI 1295891083
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522713600000",
"number": "1508966730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 EAST 3RD STREET",
"city": "DULUTH",
"state": "MN",
"postal_code": "55805",
"telephone_number": "218-766-8364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 W QUINCE ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558113338",
"telephone_number": "218-724-3472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORSAK",
"first_name": "CHARLES",
"credential": "LP, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2018-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "718213900",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.