Individual provider Active NPI

Leslie Ann Groome, L,P,C,C,

  • Professional Counselor
  • New Brighton, MN
National Provider Identifier
1891175824
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC01005 Issued in MN
Practice address
1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786
Phone
(651) 628-9566
NPI assigned
Jun 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC01005 MN Primary
Registered Nurse 163W00000X R 106172-1 MN

Addresses

Primary practice location

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786

Mailing address

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786
Phone (651) 628-9566

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
I20240109000382 MN Practitioner - Mental Health Counselor 8921459546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1789

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC01005MNMDProfessional Counselor
R 106172-1MNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Jan 1, 2024 Accepting new patients

Locations

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

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": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438646400000",
    "number": "1891175824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "address_2": "SUITE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "address_2": "SUITE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROOME",
        "first_name": "LESLIE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "L,P,C,C,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01005",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R 106172-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brighton, MN

Sources for this page

Verify at the official NPI Registry.