NPIMap

Individual provider Active NPI

Cindi Brockhaus, PSYD, LP

  • Clinical Psychologist
  • Maple Grove, MN
National Provider Identifier
1972955268
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP6079 Issued in MN
Practice address
13603 80TH Cir N
Maple Grove, MN 55369
Phone
(763) 274-3120
NPI assigned
Jul 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP6079 MN Primary

Addresses

Primary practice location

13603 80TH Cir N
Maple Grove, MN 55369

Mailing address

2855 Campus Dr Ste 660
Plymouth, MN 55441-2665

Other practice location 1

13603 80th Cir N
Maple Grove, MN 55369-8961
Phone (763) 274-3120

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cbrockhaus400180@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170123001104 MN Practitioner - Clinical Psychologist 8022390350 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

2855 Campus Dr
Suite 400
Plymouth, MN 55441-2659
Phone (763) 577-7400

2855 Campus Dr
Suite 660
Plymouth, MN 55441-2665
Phone (763) 577-7900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP6079MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Support Services Inc. CurrentSince Jan 1, 2024 Accepting new patients
Allina Health System CurrentSince Jul 16, 2018 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Jul 16, 2018 Accepting new patients
Nystrom & Associates, LTD CurrentSince Dec 18, 2016 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Jan 13, 2023 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

13603 80th Cir N
Maple Grove, MN 55369
Phone (763) 274-3120

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2855 Campus Dr
Ste 400
Plymouth, MN 55441
Phone (612) 577-7400

2855 Campus Dr
Ste 660
Plymouth, MN 55441
Phone (763) 577-7900

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Organizations & group practices 7

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.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1972955268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 CAMPUS DR STE 660",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13603 80TH CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-274-3120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13603 80th Cir N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553698961",
            "country_code": "US",
            "telephone_number": "763-274-3120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCKHAUS",
        "first_name": "CINDI",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cbrockhaus400180@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "2855 Campus Dr Ste 660",
            "city": "Plymouth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554412665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.