Individual provider Active NPI

Dana Brandenburg, PSYD, LP

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1548296502
Registry record updated Jul 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP 4535 Issued in MN
Practice address
2020 E 28TH St
Ufp Smiley'S Clinic
Minneapolis, MN 55407-1394
Phone
(612) 333-0770
Fax
(612) 333-1986
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2010

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 LP 4535 MN Primary

Addresses

Primary practice location

2020 E 28TH St
Ufp Smiley'S Clinic
Minneapolis, MN 55407-1394

Mailing address

2020 E 28TH St
Ufp Smiley'S Clinic
Minneapolis, MN 55407-1394
Phone (612) 333-0770

Other identifiers 9

IdentifierTypeStateIssuer
615T1BROtherMNBCBS SMILEY'S
61-53755OtherMNUBH
A049OtherMNCHAMPUS
1042740OtherMNPREFERRED ONE
175R2BROtherMNBCBS
HP48442OtherMNHEALTHPARTNERS
577460800MedicaidMN
113221OtherMNUCARE
2280059OtherMNARAZ

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
I20050105000613 MN Practitioner - Clinical Psychologist 3274581368 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP 4535MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Oct 28, 2022 Accepting new patients
Fairview Express Care CurrentSince Mar 24, 2019 Accepting new patients
Fairview Express Care CurrentSince Mar 24, 2019 Accepting new patients
Fairview Express Care Current Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Oct 28, 2022 Accepting new patients
Karol, PC Clinical PastSince May 1, 2002 Accepting new patients
Brain Health Group LLC PastSince Feb 7, 2021 Accepting new patients

Locations

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

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

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

2020 E 28th St
Minneapolis, MN 55407
Phone (612) 333-0770

2450 Riverside Ave
Fl 2A
Minneapolis, MN 55454

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

Organizations & group practices 7

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279065600000",
    "number": "1548296502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 E 28TH ST",
            "address_2": "UFP SMILEY'S CLINIC",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071394",
            "telephone_number": "612-333-0770",
            "fax_number": "612-333-1986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 E 28TH ST",
            "address_2": "UFP SMILEY'S CLINIC",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071394",
            "telephone_number": "612-333-0770",
            "fax_number": "612-333-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDENBURG",
        "first_name": "DANA",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2010-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 4535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SMILEY'S",
            "identifier": "615T1BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "61-53755",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "A049",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1042740",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "175R2BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP48442",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "577460800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "113221",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "2280059",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.