NPIMap

Organization Active NPI

Optimal Brain MN, PLLC

  • Clinical Psychologist
  • Oakdale, MN
National Provider Identifier
1609614957
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
OPTIMAL BRAIN MN, PLLC
Practice address
992 Inwood Ave
Oakdale, MN 55128
Phone
(651) 263-4438
NPI assigned
Jul 19, 2024
Last updated
Jul 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Authorized official

Name
Calsey FaschingNPI 1194232975
Title
Founder
Phone
(651) 263-4438

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
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

992 Inwood Ave
Oakdale, MN 55128

Mailing address

992 Inwood Ave
Oakdale, MN 55128
Phone (651) 263-4438

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241001002954 MN Part B Supplier - Clinic/Group Practice 6709317787 Receives reassigned benefits from 25 practitioners
Practice locations: Coon Rapids, MN; Minneapolis, MN; Oakdale, MN

National Provider Directory

National Provider Directory

Locations

150 3rd Ave S
Minneapolis, MN 55401
Phone (612) 472-5915

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1721347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1609614957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "992 INWOOD AVE",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "55128",
            "telephone_number": "651-263-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "992 INWOOD AVE",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "55128",
            "telephone_number": "651-263-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL BRAIN MN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-19",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "FASCHING",
        "authorized_official_first_name": "CALSEY",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "651-263-4438"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakdale, MN

Sources for this page

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