NPIMap

Individual provider Active NPI

Judy Lynn Heimlich, M.A., L.P.

  • Psychologist
  • Fridley, MN
National Provider Identifier
1700938081
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP 3651 Issued in MN
Practice address
7590 Lyric LN NE
Fridley, MN 55432-3251
Phone
(763) 236-3800
NPI assigned
Jan 17, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP 3651 MN Primary

Addresses

Primary practice location

7590 Lyric LN NE
Fridley, MN 55432-3251

Mailing address

1457 Arden View Dr
Arden Hills, MN 55112-1941
Phone (651) 636-4176

Other identifiers 2

IdentifierTypeStateIssuer
45Q48HE & 45Q51HEOtherMNBCBS OF MN
4181781OtherMNMN TAX ID #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240411003281 MN Practitioner - Clinical Psychologist 5597104422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

520 Osborne Rd NE
Suite 210
Fridley, MN 55432-2718
Phone (763) 236-3800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LP 3651MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Feb 27, 2024 Accepting new patients
Allina Health System CurrentSince Feb 27, 2024 Accepting new patients

Locations

520 Osborne Rd NE
Ste 210
Fridley, MN 55432
Phone (763) 236-3800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

7590 Lyric Ln NE
Minneapolis, MN 55432
Phone (763) 236-3800

Interoperability endpoints

  • Direct secure messaging: jheimlich79373@excellian.direct.allina.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1700938081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1457 ARDEN VIEW DR",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551121941",
            "telephone_number": "651-636-4176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7590 LYRIC LN NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323251",
            "telephone_number": "763-236-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIMLICH",
        "first_name": "JUDY",
        "middle_name": "LYNN",
        "credential": "M.A., L.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP 3651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "45Q48HE  & 45Q51HE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN TAX ID #",
            "identifier": "4181781",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.