Ann Colleen O'Fallon, MA, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4090 Issued in MN

Practice address

3737 Colfax Ave S
Minneapolis, MN 55409-1023

Phone

(612) 720-9266

NPI assigned

Jan 14, 2016

Last updated

Jan 14, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Group practices

Shoreview Mental Health Center LLCGroup PAC ID 6204121338, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shoreview Mental Health Center, LLC

  • Psychologist
  • Shoreview, MN
  • NPI 1558735779
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1952767311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 COLFAX AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091023",
            "telephone_number": "612-720-9266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 COLFAX AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091023",
            "telephone_number": "612-720-9266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'FALLON",
        "first_name": "ANN",
        "middle_name": "COLLEEN",
        "name_prefix": "Ms.",
        "credential": "MA, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis John O'Donnell, PT
• Kevin Merlin O'Donnell, MD
• Mary T O'Donnell, CNP
• Lauren Ireland O'Dougherty, BCBA
• William Thomas O'Dowd, PH.D.
• Jessen Faee O'Fallon
• Katherine Louise O'Flynn O'Brien
• Jacqueline Ann O'Gara-Jung, MA, LPCC
• George Timothy O'Gara
• Laura Ann O'Gorman, DC

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; 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.