Martha Barck, CNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Northfield, MN
NPI 1629663141 · NPPES record last updated Mar 30, 2023
Key facts
- NPI
- 1629663141
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 8059 (MN)
- Practice address
- 1400 Jefferson Rd
Northfield, MN 55057-3081 - Phone
- (507) 663-9000
- NPI assigned
- Mar 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Allina Health System
Practice addresses (Care Compare)
440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210914001933 | MN | Practitioner - Nurse Practitioner | 7911302153 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8059 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current |
Accepting new patients | |
| Secure Base Counseling Center LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Current |
Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
1400 Jefferson Rd
Northfield, MN 55057
Phone (507) 663-9000
570 Professional Dr
Northfield, MN 55057
Phone (507) 301-3412
Interoperability endpoints
- mbarck601702@excellian.direct.allina.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 8059 | MN | Yes |
Addresses
Primary practice location
1400 Jefferson Rd
Northfield, MN 55057-3081
Mailing address
570 Professional Dr
Northfield, MN 55057-2756
Phone (507) 301-3412
Other practice location 1
570 Professional Dr
Northfield, MN 55057-2756
Phone (507) 301-3412
Other names
- Martha Dompierre
Other providers in Northfield, MN
- Heidi Lee Auge
- Azule Opportunities, LLC
- John R Bailey
- Jennifer Bakke
- Dana Marija Balukas
- Baremed PLLC
- Erin Barnett
- Claire L Bartlett
- Dayne Marcus Bartlett
- Deborah Sue Bauer
All providers in Northfield, MN · Psychiatric/Mental Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.