Suzanne E Derheim, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2849 Issued in MN

Practice address

5500 94TH Ave N
Brooklyn Park, MN 55443-1992

Phone

(763) 762-8835

Fax

(763) 315-6678

NPI assigned

Feb 15, 2017

Last updated

Sep 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Marriage and Family Therapist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Croix Psychiatric LLCGroup PAC ID 9335288786, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• St. Croix Psychiatric, LLC

  dba PrairieCare Medical Group

  • Psychiatry Physician
  • Woodbury, MN
  • NPI 1881849586

  Marriage & Family Therapist

  Medicare reassignment Care Compare group NPD
• Prairiecare LLC

  dba PrairieCare

  • Psychiatric Hospital
  • Brooklyn Park, MN
  • NPI 1215182928

  Marriage & Family Therapist

  NPD (past)

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

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1548709140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 94TH AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431992",
            "telephone_number": "763-762-8835",
            "fax_number": "763-315-6678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 94TH AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431992",
            "telephone_number": "763-762-8835",
            "fax_number": "763-315-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERHEIM",
        "first_name": "SUZANNE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-15",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355355800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olujimi Mobolaji Dawodu
• Isaac-Moise Ayaovi Mawunyo De Saba, LPC
• Sia Dean, RN
• Delight Home Healthcare, LLC
• Russell S Derhak, D.C.
• Desnol Healthcare Services
• Desvito Inc (There's No Place Like Home Health Care)
• Devine Healthcare Services
• Diamond Home & Community Support Service
• King David Dickson

• Marriage & Family Therapist in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.