Justin Donald Graham, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

52451 Issued in MN

Practice address

6363 France Ave S Ste 200
Edina, MN 55435-2140

Phone

(952) 230-9100

Fax

(952) 922-2525

NPI assigned

Aug 5, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Croix Psychiatric, LLC

  • Psychiatry Physician
  • Woodbury, MN
  • NPI 1881849586
  Medicare reassignment NPD
• Prairiecare LLC

  • Psychiatric Hospital
  • Brooklyn Park, MN
  • NPI 1215182928
  NPD (past)

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1720244163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352140",
            "telephone_number": "952-230-9100",
            "fax_number": "952-922-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352140",
            "telephone_number": "952-230-9100",
            "fax_number": "952-922-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "JUSTIN",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-05",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MN",
            "license": "52451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul S. Gotlieb, M.D.
• Erin Marie Gottesleben, PA-C
• Jennifer Ann Goudy, MA
• Isabella Goulett
• Elise Graham, RD, LD
• Maggie Allison Graham, MSW, LICSW
• Sarah Wilson Grahn, MD
• Jessica L Grajczyk, DO
• Grand St Paul CVS LLC
• Grand St. Paul CVS LLC

• Child & Adolescent Psychiatry Physician in Edina, MN
• Providers in Edina, MN by specialty
• Child & Adolescent Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.