NPIMap

Organization Active NPI

Aurora Psychological Services LLC

  • Clinical Psychologist
  • Eagan, MN
National Provider Identifier
1649378019
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP4645 Issued in MN
Legal business name
AURORA PSYCHOLOGICAL SERVICES LLC
Practice address
4660 Slater Rd
Suite 210
Eagan, MN 55122-4047
Phone
(651) 882-6299
Fax
(651) 882-6299
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Dr. Annie Elizabeth Emanuel, PSYDNPI 1205274990
Title
Licensed Psychologist
Phone
(651) 274-1203

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 PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X LP4645 MN Primary

Addresses

Primary practice location

4660 Slater Rd
Suite 210
Eagan, MN 55122-4047

Mailing address

4660 Slater Rd
Suite 210
Eagan, MN 55122-4047
Phone (651) 882-6299

Other identifiers 4

IdentifierTypeStateIssuer
83G50OLOtherMNBLUE CROSS BLUE SHIELD
084673200MedicaidMN
138155OtherMNUCARE
HP58813OtherMNHEALTH PARTNERS

Other names 2

  • Aurora Psychological Services Doing business as
  • Roger Olsen Psy LP LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060202000919 MN Part B Supplier - Clinic/Group Practice 5294749883 Receives reassigned benefits from 3 practitioners
Practice locations: Eagan, MN

National Provider Directory

National Provider Directory

Locations

4660 Slater Rd
Ste 210
Saint Paul, MN 55122
Phone (651) 681-8615

Practitioners 8

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1649378019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE 210",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224047",
            "telephone_number": "651-882-6299",
            "fax_number": "651-683-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE 210",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224047",
            "telephone_number": "651-882-6299",
            "fax_number": "651-882-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "EMANUEL",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "651-274-1203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "83G50OL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084673200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "138155",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP58813",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aurora Psychological Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aurora Psychological Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Roger Olsen Psy LP LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.