Active NPI
Mark Anderson, PHD LP
- Psychologist
- Fairmont, MN
National Provider Identifier
1942285192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP1721
- Practice address
- 800 Medical Center Dr
Fairmont, MN 56031-4575 - Phone
- (507) 238-8555
- NPI assigned
- Dec 9, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP1721 | MN | Primary |
Addresses
Primary practice location
800 Medical Center Dr
Fairmont, MN 56031-4575
Mailing address
800 Medical Center Dr
PO Box 800
Fairmont, MN 56031-4575
Phone (507) 238-8555
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114910 | Medicaid | MN | |
| 40D59AN | Other | MN | BLUE CROSS |
| 40D59AN | Medicaid | MN | |
| 7314 | Other | MN | AVERA |
| HP18890 | Other | MN | HEALTHPARTNERS |
| A031 | Other | MN | CHAMPUS |
| MH9041009757 | Other | MN | PREFERREDONE |
| 862668 | Other | MN | ARAZ |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1721 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1942285192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"address_2": "PO BOX 800",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MARK",
"credential": "PHD LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP1721",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114910",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "40D59AN",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40D59AN",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVERA",
"identifier": "7314",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP18890",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "A031",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "MH9041009757",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "862668",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.