Individual provider Active NPI

Saari Anne McCornack, PSYD

  • Clinical Psychologist
  • Big Lake, MN
National Provider Identifier
1518437912
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5789 Issued in MN
Practice address
207 Jefferson Blvd
Big Lake, MN 55309-4667
Phone
(763) 263-7897
NPI assigned
Nov 28, 2018
Last updated
Nov 28, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5789 MN Primary

Addresses

Primary practice location

207 Jefferson Blvd
Big Lake, MN 55309-4667

Mailing address

1900 Silver Lake Rd NW
New Brighton, MN 55112-1786
Phone (651) 379-1718

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
I20210504000561 MN Practitioner - Clinical Psychologist 0941619944 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5789MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Karol, PC Clinical CurrentSince May 17, 2023 Accepting new patients
Fairview Express Care Current Accepting new patients
Hennepin County CurrentSince May 10, 2021 Accepting new patients
Brain Health Group LLC CurrentSince May 17, 2023 Accepting new patients
Fairview Express Care CurrentSince Oct 23, 2021 Accepting new patients
Hennepin County Clinical Current Accepting new patients
Fairview Express Care CurrentSince Oct 23, 2021 Accepting new patients
Hennepin County CurrentSince May 10, 2021 Accepting new patients
Nystrom & Associates, LTD PastSince Mar 10, 2023 Accepting new patients
Family Support Services Inc. Past Accepting new patients

Locations

11800 Singletree Ln
Ste 203
Eden Prairie, MN 55344
Phone (651) 503-9404

1801 Nicollet Ave
Minneapolis, MN 55403
Phone (612) 596-0900

2215 E Lake St
Minneapolis, MN 55407
Phone (612) 596-0900

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

2700 Snelling Ave N
Ste 400
Saint Paul, MN 55113
Phone (651) 697-5804

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543363200000",
    "number": "1518437912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-379-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 JEFFERSON BLVD",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553094667",
            "telephone_number": "763-263-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORNACK",
        "first_name": "SAARI",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-28",
        "last_updated": "2018-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "5789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Big Lake, MN

Sources for this page

Verify at the official NPI Registry.