Active NPI
Mark Theodore Orth, LP
- Clinical Psychologist
- McGrath, MN
National Provider Identifier
1811149651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4963
- Practice address
- 16809 260TH Ave
MC Grath, MN 56350-4538 - Phone
- (320) 676-1757
- NPI assigned
- Oct 10, 2008
- Last updated
- Oct 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4963 | MN | Primary |
Addresses
Primary practice location
16809 260TH Ave
MC Grath, MN 56350-4538
Mailing address
16809 260TH Ave
MC Grath, MN 56350-4538
Phone (320) 676-1757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gray Matter Partners | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Adult Mental Health Clinic/Center
- McGrath, MN
- NPI 1083987291
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223596800000",
"number": "1811149651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16809 260TH AVE",
"city": "MC GRATH",
"state": "MN",
"postal_code": "563504538",
"telephone_number": "320-676-1757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16809 260TH AVE",
"city": "MC GRATH",
"state": "MN",
"postal_code": "563504538",
"telephone_number": "320-676-1757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTH",
"first_name": "MARK",
"middle_name": "THEODORE",
"credential": "LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-10",
"last_updated": "2008-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McGrath, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.