Philip David Imholte, PSYD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP6876 Issued in MN

Practice address

3259 Zarthan Ave S
Minneapolis, MN 55416-2062

Phone

(320) 828-0864

NPI assigned

Oct 4, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Neuropsychology LLCGroup PAC ID 3375602931, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Northeast Neuropsychology, LLC

  • Clinical Neuropsychologist
  • Cheshire, CT
  • NPI 1396991956
  Medicare reassignment Care Compare group NPD
• Advanced Telepsych PLLC

  • Psychiatry Physician
  • Middletown, CT
  • NPI 1508456377
  NPD (past)

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

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1740821214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3259 ZARTHAN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162062",
            "telephone_number": "320-828-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3259 ZARTHAN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162062",
            "telephone_number": "320-828-0864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 Mill St",
            "address_purpose": "LOCATION",
            "city": "Westfield",
            "state": "MA",
            "postal_code": "010854598",
            "country_code": "US",
            "telephone_number": "413-568-6141",
            "fax_number": "413-572-4117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMHOLTE",
        "first_name": "PHILIP",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-04",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CT",
            "license": "004270",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP6876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iman's Care
• Tamunokubie Imbu Jr.
• Brian Holm Imdieke, CNP
• Mary Elizabeth Imdieke
• Renee Monique Imes
• Kailey Immen, PA-C
• Katie Immerfall-Strasburg, LPCC
• Impact Orthodontics, PLLC
• Imran Healthcare Services, LLC
• In Full Bloom Counseling, LLC

• Counseling Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.

Verify at the official NPI Registry.