NPIMap

Individual provider Active NPI

Jason Edward Kisser, PH.D.

  • Clinical Neuropsychologist
  • Minneapolis, MN
National Provider Identifier
1770141673
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
LP6782 Issued in MN
Practice address
3915 Golden Valley Rd
Minneapolis, MN 55422-4249
Phone
(612) 262-3464
NPI assigned
Jun 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 6301017201 MI
Clinical Psychologist 103TC0700X LP6782 MN
Clinical Psychologist 103TC0700X 6301017201 MI
Clinical Neuropsychologist 103G00000X LP6782 MN Primary

Addresses

Primary practice location

3915 Golden Valley Rd
Minneapolis, MN 55422-4249

Mailing address

3915 Golden Valley Rd
Minneapolis, MN 55422-4249

Other practice location 1

18181 Oakwood Blvd Ste 411
Dearborn, MI 48124-4082
Phone (313) 982-5150

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkisser1009846@direct.beaumont.edu

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
I20220607003264 MN Practitioner - Clinical Psychologist 7719216001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of Maryland School of Medicine, 2017
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)

800 E 28TH St
Suite 1750
Minneapolis, MN 55407-3723
Phone (612) 863-4495

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
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

LicenseStateTypeSpecialty
6301017201MIMDClinical Neuropsychologist
LP6782MNMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Jul 20, 2022 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Jul 20, 2022 Accepting new patients

Locations

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

3915 Golden Valley Rd
Minneapolis, MN 55422
Phone (612) 588-0811

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

800 E 28th St
Ste 1750
Minneapolis, MN 55407
Phone (612) 863-4495

Interoperability endpoints

  • Direct secure messaging: jkisser1009846@direct.beaumont.edu
  • Direct secure messaging: jkisser585982@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 and National Provider Directory roles.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1770141673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 GOLDEN VALLEY RD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554224249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 GOLDEN VALLEY RD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554224249",
            "telephone_number": "612-262-3464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18181 Oakwood Blvd Ste 411",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481244082",
            "country_code": "US",
            "telephone_number": "313-982-5150",
            "fax_number": "313-982-5157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISSER",
        "first_name": "JASON",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301017201",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6782",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301017201",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP6782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkisser1009846@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "18181 Oakwood Blvd Ste 411",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481244082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.