Northtown Psychology Associates – Psychologist, NPI 1174573067
Psychologist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Northtown Psychology Associates
199 COON RAPIDS BLVD NW STE 113
COON RAPIDS, MN 554335859
Phone: (763) 785-8111
Fax: (763) 785-6946
Type: Mailing
Coon Rapids Boulevard Northwest, Parkside, Coon Rapids, Anoka County, Minnesota, 55433, United States
SUITE 310
COON RAPIDS, MN 554335831
Phone: (763) 785-8111
Fax: (763) 785-8111
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-09-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-02-28 (102 days ago).
Enrollment records
1
Earliest due date
2026-02-28
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050916000385 | O | Clinic/Group Practice | MN | 2026-02-28 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55433)
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