Active NPI
Kenneth Bruce Sutherland, L.P.
- Psychologist
- Bloomington, MN
National Provider Identifier
1952434029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP1175
- Practice address
- 7800 Metro Pkwy
Suite 300
Bloomington, MN 55425-1514 - Phone
- (952) 854-6066
- Fax
- (952) 854-6766
- NPI assigned
- Mar 14, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP1175 | MN | Primary |
Addresses
Primary practice location
7800 Metro Pkwy
Suite 300
Bloomington, MN 55425-1514
Mailing address
7800 Metro Pkwy
Suite 300
Bloomington, MN 55425-1514
Phone (952) 854-6066
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 553869 | Other | MN | VALUE OPTIONS |
| 990990306005 | Other | MN | PREFERRED ONE |
| 101776 | Other | MN | UCARE |
| 6237451 | Other | MN | MEDICA |
| 3033056 | Other | MN | HEALTH PARTNERS |
| 64G51SU | Other | MN | BLUE CROSS BLUE SHIELD MN |
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 |
|---|---|---|---|
| LP1175 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1952434029",
"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": "952-854-6066",
"fax_number": "952-854-6766"
},
{
"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": "952-854-6066",
"fax_number": "952-854-6766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLAND",
"first_name": "KENNETH",
"middle_name": "BRUCE",
"name_prefix": "Mr.",
"credential": "L.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP1175",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "553869",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "990990306005",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "101776",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6237451",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "3033056",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MN",
"identifier": "64G51SU",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, 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.