Organization Active NPI

Behavioral Medicine Associates, Inc.

  • Cognitive & Behavioral Psychologist
  • Edina, MN
National Provider Identifier
1760549893
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
BEHAVIORAL MEDICINE ASSOCIATES, INC.
Practice address
4820 77TH St W Ste 135
Edina, MN 55435-4822
Phone
(952) 844-0619
Fax
(952) 844-0628
NPI assigned
Jan 1, 2007
Last updated
Nov 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Authorized official

Name
Ms. Elizabeth M. Nash, M.A.NPI 1558508200
Title
Manager
Phone
(952) 844-0619

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
Cognitive & Behavioral Psychologist 103TB0200X NU Primary

Addresses

Primary practice location

4820 77TH St W Ste 135
Edina, MN 55435-4822

Mailing address

4820 77TH St W Ste 135
Edina, MN 55435-4822
Phone (952) 844-0619

Other identifiers 2

IdentifierTypeStateIssuer
4K592BEOtherMNBCBSMN GROUP #
1790842821MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080909000401 MN Part B Supplier - Clinic/Group Practice 7012083405 Receives reassigned benefits from 2 practitioners
Practice locations: Edina, MN

National Provider Directory

National Provider Directory

Locations

3300 Edinborough Way
Ste 204
Edina, MN 55435
Phone (952) 844-0619

4820 77th St W
Ste 135
Minneapolis, MN 55435
Phone (952) 380-8930

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1760549893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4820 77TH ST W STE 135",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354822",
            "telephone_number": "952-844-0619",
            "fax_number": "952-844-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4820 77TH ST W STE 135",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354822",
            "telephone_number": "952-844-0619",
            "fax_number": "952-844-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL MEDICINE ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-01",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "NASH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "952-844-0619",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN GROUP #",
            "identifier": "4K592BE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790842821",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.