Active NPI
Ronald J Berk, M.EQ., LP
- Clinical Psychologist
- Minneapolis, MN
National Provider Identifier
1912049032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP0981
- Practice address
- 2104 Northdale Blvd NW
Suite 220
Minneapolis, MN 55433-3028 - Phone
- (763) 537-6000
- NPI assigned
- Feb 13, 2007
- 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 | LP0981 | MN | Primary |
Addresses
Primary practice location
2104 Northdale Blvd NW
Suite 220
Minneapolis, MN 55433-3028
Mailing address
5212 Abercrombie Dr
Edina, MN 55439-1451
Phone (952) 944-7284
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 965747900 | Other | MN | MINNESOTA PROVIDER NUMBR |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP0981 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235001600000",
"number": "1912049032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5212 ABERCROMBIE DR",
"city": "EDINA",
"state": "MN",
"postal_code": "554391451",
"telephone_number": "952-944-7284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 NORTHDALE BLVD NW",
"address_2": "SUITE 220",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554333028",
"telephone_number": "763-537-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERK",
"first_name": "RONALD",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "M.EQ., LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2009-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP0981",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MINNESOTA PROVIDER NUMBR",
"identifier": "965747900",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.