NPIMap

Organization Active NPI

Shoreview Mental Health Center, LLC

  • Psychologist
  • Shoreview, MN
National Provider Identifier
1558735779
Registry record updated Feb 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP5097 Issued in MN
Legal business name
SHOREVIEW MENTAL HEALTH CENTER, LLC
Practice address
5985 Rice Creek Pkwy Ste 201
Shoreview, MN 55126-5037
Phone
(651) 348-7240
Fax
(651) 348-7265
NPI assigned
Nov 27, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2018

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

Authorized official

Name
Jeanette Balfe-Groh, LP,PSYDNPI 1730365511
Title
Managing Member
Phone
(651) 247-8128

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X LP5097 MN Primary

Addresses

Primary practice location

5985 Rice Creek Pkwy Ste 201
Shoreview, MN 55126-5037

Mailing address

5985 Rice Creek Pkwy Ste 201
Shoreview, MN 55126-5037
Phone (651) 247-8128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160829000373 MN Part B Supplier - Clinic/Group Practice 6204121338 Receives reassigned benefits from 5 practitioners
Practice locations: Minneapolis, MN; Shoreview, MN

National Provider Directory

National Provider Directory

Locations

5985 Rice Creek Pkwy
Ste 201
Shoreview, MN 55126
Phone (651) 348-7240

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1448582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519689600000",
    "number": "1558735779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5985 RICE CREEK PKWY STE 201",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265037",
            "telephone_number": "651-247-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5985 RICE CREEK PKWY STE 201",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265037",
            "telephone_number": "651-348-7240",
            "fax_number": "651-348-7265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOREVIEW MENTAL HEALTH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-27",
        "last_updated": "2018-02-27",
        "status": "A",
        "authorized_official_last_name": "BALFE-GROH",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "651-247-8128",
        "authorized_official_credential": "LP,PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; 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.