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2121 Campus Dr Se Rochester MN 55904-4744 | |
| (763) 551-8640 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2121 Campus Dr Se, Rochester, Minnesota |
| Authorized Official Name and Position | Lisa Asper (CONTRACT MANAGER) |
| Authorized Official Contact | 7632268397 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2121 Campus Dr Se Rochester MN 55904-4744 Ph: (763) 551-8640 | 2121 Campus Dr Se Rochester MN 55904-4744 Ph: (763) 551-8640 |
| NPI Number | 1851905251 |
|---|---|
| Provider Enumeration Date | 09/02/2020 |
| Last Update Date | 11/10/2021 |
| Certification Date | 11/10/2021 |
| Medicare PECOS PAC ID | 5395133714 |
|---|---|
| Medicare Enrollment ID | O20211103002491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851905251 | NPI | - | NPPES |
| 11-1111111 | Other | MN | FEE FOR SERVICE |
| 22-2222222 | Medicaid | MN |
| Provider Name | Bruce Sutor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508846684 PECOS PAC ID: 3577608801 Enrollment ID: I20100310001004 |
| Provider Name | Sheila A Hoemberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689753741 PECOS PAC ID: 0446425763 Enrollment ID: I20111214000478 |
| Provider Name | Monica J Taylor-desir |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770613259 PECOS PAC ID: 9335053800 Enrollment ID: I20190523001908 |
| Provider Name | Glenda M Vian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538704317 PECOS PAC ID: 7113354580 Enrollment ID: I20200225000015 |
| Provider Name | Kathryn Maureen Shelton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821558081 PECOS PAC ID: 8820323272 Enrollment ID: I20200922001984 |
| Provider Name | Alexa R Just |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114512548 PECOS PAC ID: 2567863475 Enrollment ID: I20210630000312 |
| Provider Name | Caitlin Callahan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952183808 PECOS PAC ID: 3072966571 Enrollment ID: I20240131004658 |
| Provider Name | Ashley Elizabeth Sporer Evenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376100412 PECOS PAC ID: 0042654097 Enrollment ID: I20240216003834 |
| Provider Name | Amanda Mindela |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760134092 PECOS PAC ID: 6305280975 Enrollment ID: I20240222001266 |
| Provider Name | Drew Alan Pate |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073552063 PECOS PAC ID: 2163658170 Enrollment ID: I20240223000096 |
| Provider Name | Cindy L Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164700977 PECOS PAC ID: 9638516412 Enrollment ID: I20240328002674 |
| Provider Name | Jaime Swift |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881063675 PECOS PAC ID: 5496291825 Enrollment ID: I20240722003772 |
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