Active NPI
Austin Jacobsen
- Mental Health Counselor
- Mendota Heights, MN
National Provider Identifier
1558040105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1370 Mendota Heights Rd
Mendota Heights, MN 55120-1281 - Phone
- (651) 313-8080
- NPI assigned
- Jul 12, 2023
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1370 Mendota Heights Rd
Mendota Heights, MN 55120-1281
Mailing address
12301 Nicollet Ave Apt 2404
Burnsville, MN 55337-2930
Phone (920) 242-5615
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240115000630 | MN | Practitioner - Mental Health Counselor | 9638521784 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4048 | MN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nystrom & Associates, LTD | 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.
-
- Clinical Social Worker
- New Brighton, MN
- NPI 1396750188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689120000000",
"number": "1558040105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12301 NICOLLET AVE APT 2404",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553372930",
"telephone_number": "920-242-5615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1370 MENDOTA HEIGHTS RD",
"city": "MENDOTA HEIGHTS",
"state": "MN",
"postal_code": "551201281",
"telephone_number": "651-313-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "AUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-12",
"last_updated": "2023-07-12",
"certification_date": "2023-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mendota Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.