WISDOM PSYCHIATRIC CARE AND MEDICATION MANAGEMENT LLC – Mental Health Clinic/Center (Including Community Mental Health Center), NPI 1255925962
Mental Health Clinic/Center (Including Community Mental Health Center)
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for WISDOM PSYCHIATRIC CARE AND MEDICATION MANAGEMENT LLC
8628 HASTINGS ST NE
BLAINE, MN 554494252
Phone: (320) 232-0647
Fax: (567) 205-3614
Type: Mailing
2704 MOUNDS VIEW BLVD
STE 12
MOUNDS VIEW, MN 55112
Phone: (320) 232-0647
Fax: (567) 205-3614
Type: Location
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: 2021-06-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-06-30 (20 days away).
Enrollment records
1
Earliest due date
2026-06-30
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 |
|---|---|---|---|---|
| O20210602002788 | O | Clinic/Group Practice | MN | 2026-06-30 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
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 55449)
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