Active NPI
Joe Groninga, PSYD
- Psychologist
- Saint Paul, MN
National Provider Identifier
1528343449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5400
- Practice address
- 2383 University Ave W
Suite 200
Saint Paul, MN 55114-1603 - Phone
- (651) 644-4100
- Fax
- (651) 644-4885
- NPI assigned
- Oct 12, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 5400 | MN | Primary |
Addresses
Primary practice location
2383 University Ave W
Suite 200
Saint Paul, MN 55114-1603
Mailing address
2383 University Ave W
Suite 200
Saint Paul, MN 55114-1603
Phone (651) 644-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5400 | MN | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318377600000",
"number": "1528343449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2383 UNIVERSITY AVE W",
"address_2": "SUITE 200",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551141603",
"telephone_number": "651-644-4100",
"fax_number": "651-644-4885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2383 UNIVERSITY AVE W",
"address_2": "SUITE 200",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551141603",
"telephone_number": "651-644-4100",
"fax_number": "651-644-4885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRONINGA",
"first_name": "JOE",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-12",
"last_updated": "2011-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "5400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.