Active NPI
Kent David Smallwood, PH.D.
- Clinical Psychologist
- Center City, MN
National Provider Identifier
1679767016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP5358
- Practice address
- 15251 Pleasant Valley Rd # Co7
Center City, MN 55012-9640 - Phone
- (651) 213-4169
- Fax
- (651) 213-4515
- NPI assigned
- Aug 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP5358 | MN | Primary |
Addresses
Primary practice location
15251 Pleasant Valley Rd # Co7
Center City, MN 55012-9640
Mailing address
15251 Pleasant Valley Rd # Co7
PO Box 11
Center City, MN 55012-9640
Phone (651) 213-4169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9058 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ksmallwood316057@excellian.direct.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000
3915 Golden Valley Rd
Golden Valley, MN 55422-4249
Phone (612) 775-2455
PO Box
Minneapolis, MN 55440-0043
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.6 of 100
- Quality
- 72.5
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.07
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP5358 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients |
Locations
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
800 E 28th St
Ste 1750
Minneapolis, MN 55407
Phone (612) 863-4495
Interoperability endpoints
- ksmallwood316057@excellian.direct.allina.com
Organizations & group practices 2
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.
-
- Obstetrics & Gynecology Physician
- Buffalo, MN
- NPI 1295272342
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1679767016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15251 PLEASANT VALLEY RD # CO7",
"address_2": "PO BOX 11",
"city": "CENTER CITY",
"state": "MN",
"postal_code": "550129640",
"telephone_number": "651-213-4169",
"fax_number": "651-213-4515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15251 PLEASANT VALLEY RD # CO7",
"city": "CENTER CITY",
"state": "MN",
"postal_code": "550129640",
"telephone_number": "651-213-4169",
"fax_number": "651-213-4515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALLWOOD",
"first_name": "KENT",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-29",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP5358",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9058",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ksmallwood316057@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "15251 Pleasant Valley Rd # Co7",
"city": "Center City",
"state": "MN",
"country_code": "US",
"postal_code": "550129640",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Center City, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.