Thomas Michael Misukanis Sr., PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

LP3921 Issued in MN

Practice address

7800 Metro Pkwy
Suite 300
Bloomington, MN 55425-1514

Phone

(952) 876-0727

Fax

(952) 851-9618

NPI assigned

Dec 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Minnesota Clinical & Neuropsychological Associates, P.a.

  • Clinical Neuropsychologist
  • Bloomington, MN
  • NPI 1679633093
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1922168244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7800 METRO PKWY",
            "address_2": "SUITE 300",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251514",
            "telephone_number": "952-876-0727",
            "fax_number": "952-851-9618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 METRO PKWY",
            "address_2": "SUITE 300",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251514",
            "telephone_number": "952-876-0727",
            "fax_number": "952-851-9618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISUKANIS",
        "first_name": "THOMAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "1929",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3921",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "1929",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP3921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "460980800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Minnesota Masonic Home Care Center
• Minnesota Multicultural Center for Health
• Minnesota Retina Associates, LLC
• Ayan Mire
• Nasteho Mire
• Mitchell Olson, DDS PA
• Jennifer Mitchell, PHARM.D.
• Kathryn Isabelle Mitchell
• Kendra Nicole Mitchell
• Nikki Renae Mitchell

• Clinical Neuropsychologist in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Clinical Neuropsychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.