Active NPI
Gregory R Simonson, PHD, LP
- Clinical Psychologist
- Moorhead, MN
National Provider Identifier
1942850003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6448
- Practice address
- 4000 28TH Ave S
Moorhead, MN 56560-7926 - Phone
- (701) 234-3200
- NPI assigned
- Sep 19, 2019
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6448 | MN | Primary |
Addresses
Primary practice location
4000 28TH Ave S
Moorhead, MN 56560-7926
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Sanford Medical Center Fargo
Practice addresses (Care Compare)
1412 Main St
Hawley, MN 56549
Phone (218) 483-3564
1611 County Rd B W
Suite 202
Roseville, MN 55113-4053
Phone (651) 300-1112
4000 28TH Ave S
Moorhead, MN 56560-7926
Phone (701) 234-3200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6448 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luminous Mind Inc | Clinical | Current | Accepting new patients |
Locations
1611 County Road B W
Ste 202
Saint Paul, MN 55113
Phone (651) 300-1112
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.
-
dba The Luminous Mind
- Community/Behavioral Health Agency
- Roseville, MN
- NPI 1588015168
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1942850003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5074",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175074",
"telephone_number": "605-328-9419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 28TH AVE S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565607926",
"telephone_number": "701-234-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONSON",
"first_name": "GREGORY",
"middle_name": "R",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-19",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "6448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; 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.