Individual provider Active NPI

Natalia V Potapova, PHD

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1861008567
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
000000 Issued in MN
Practice address
701 Park Ave # S1.110
Minneapolis, MN 55415-1623
Phone
(612) 873-2218
Fax
(612) 873-1614
NPI assigned
Sep 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 000000 MN Primary

Addresses

Primary practice location

701 Park Ave # S1.110
Minneapolis, MN 55415-1623

Mailing address

701 Park Ave # S1.110
Minneapolis, MN 55415-1623
Phone (612) 873-2218

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20210211001700 MN Practitioner - Clinical Psychologist 0840605416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
May accept Medicare assignment
Group practices
Natalis Counseling and Psychology Solutions, P.a.Group PAC ID 5193756104, 26 clinicians

Practice addresses (Care Compare)

1600 University Ave W
Saint Paul, MN 55104-3898
Phone (651) 379-5157

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
000000MNMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Natalis Counseling and Psychology Solutions, P.a. CurrentSince Feb 1, 2022 Accepting new patients

Locations

1600 University Ave W
Saint Paul, MN 55104
Phone (651) 644-1813

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1861008567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE # S1.110",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-2218",
            "fax_number": "612-873-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE # S1.110",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-2218",
            "fax_number": "612-873-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTAPOVA",
        "first_name": "NATALIA",
        "middle_name": "V",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.