Nicholas Gammello

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1437 Issued in MN

Practice address

18510 State Highway 371 Ste D
Brainerd, MN 56401-6996

Phone

(218) 838-4209

NPI assigned

Jul 24, 2006

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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 and National Provider Directory roles.

• Lakeview Behavioral Health Inc.

  • Community/Behavioral Health Agency
  • Grand Rapids, MN
  • NPI 1154404325
  Medicare reassignment NPD
• Cornerstone Counseling Center, PLLC

  • Adult Mental Health Clinic/Center
  • Brainerd, MN
  • NPI 1386461077
  NPD Authorized official
• Cornerstone Counseling Center, Inc.

  • Counseling Psychologist
  • Baxter, MN
  • NPI 1932219102
  NPD (past) Authorized official
• Lakes Country Counseling PLLC

  • Community/Behavioral Health Agency
  • Baxter, MN
  • NPI 1023322351
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1558383000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11636 FAIRWAY RD",
            "city": "EAST GULL LAKE",
            "state": "MN",
            "postal_code": "564012099",
            "telephone_number": "218-838-4209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18510 STATE HIGHWAY 371 STE D",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564016996",
            "telephone_number": "218-838-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMMELLO",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "1437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "62Q99GA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "731353500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Rae Fry, FNP
• Functional Movement Therapies
• Luke Funk
• Samantha Joanne Funk
• Kathy Sue Gaalswyk
• Tina Marie Gangestad, RDN
• Mackenzie Gangl, LICSW
• Patricia Ann Garding, LICSW
• Kristi Rae Gebhardt, D.O.
• Brittany Rose Geditz, PA

• Psychologist in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.