DR. DUSTIN BROCKBERG PHD
NPI 1801422928
Psychologist in Minneapolis, MN

NPI Status: Active since March 20, 2020

Contact Information

800 E 28TH ST STE 1750
MINNEAPOLIS, MN
ZIP 55407
Phone: (612) 863-4495

Get Directions Reviews

  • Individual
  • Male
  • Years of Experience 7
  • Psychologist
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About DUSTIN BROCKBERG

This page provides the complete NPI Profile along with additional information for Dustin Brockberg, a provider established in Minneapolis, Minnesota with a medical specialization in Psychologist and more than 7 years of experience. The healthcare provider is registered in the NPI registry with number 1801422928 assigned on March 2020. The practitioner's primary taxonomy code is 103T00000X with license number LP6577 (MN). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1801422928
Provider Name
DR. DUSTIN BROCKBERG PHD
Gender
Male
Entity Type
Individual
Location Address
800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407
Location Phone
(612) 863-4495
Mailing Address
2925 CHICAGO AVE MINNEAPOLIS, MN 55407
Mailing Phone
(612) 262-9000
Medical School Name
OTHER
Graduation Year
2019
Is Sole Proprietor?
No
Enumeration Date
03-20-2020
Last Update Date
04-27-2023
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A psychologist like Dustin Brockberg studies cognitive, emotional, social processes and behavior by observing, interpreting, and recording how people relate to one another and to their environments. Psychologists gather information and evaluate behavior through controlled laboratory experiments, psychoanalysis, psychotherapy or through personality, performance, aptitude, or intelligence tests, and use this information when testing theories in their research or when treating patients.

Location Map

Secondary Locations

  • 15251 Pleasant Valley Rd
    Center City, MN 55012
    (651) 213-4078

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Psychologist

Taxonomy Code
103T00000X
Type
Behavioral Health & Social Service Providers
License No.
LP6577
License State
MN
Taxonomy Description
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Medicare Participation & PECOS Enrollment Status

Dustin Brockberg is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Dustin Brockberg is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 9335510395

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20230130002448

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Dustin Brockberg is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
ABBOTT NORTHWESTERN HOSPITAL800 EAST 28TH STREET
MINNEAPOLIS, MN 55407
(612) 863-4000Acute Care Hospitals

Reviews for DR. DUSTIN BROCKBERG PHD

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1801422928
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
280182494
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 8 + 0 + 1 + 8 + 2 + 4 + 9 + 4 + 24 = 62
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 62 = 88

The NPI number 1801422928 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1164673380 SUZANNE MARIE SCHILTZ NP-C
Individual
Nurse Practitioner (Adult Health)800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1588628184 JACKSON W Q MADDUX MD
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1528478625DR. ARUN IDICULLA M.D.
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1336515030MR. CHRIS NELSON LICSW
Individual
Social Worker (Clinical)800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 262-1166
1639276637 SONYA CARLSON CNP
Individual
Nurse Practitioner800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1295968790 LIAT GOLDMAN MD
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750 ABBOTT NORTHWESTERN HOSPITAL
MINNEAPOLIS, MN 55407
(612) 863-4495
1235559147 ANNE CATHERINE TITA M.D.
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1134503469 NOAH JARED CHAPPELL NP
Individual
Nurse Practitioner (Adult Health)800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1568984078DR. ANDREW F FEDOR III PHD LP
Individual
Psychologist800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1013041540DR. INDRA LIM MD
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1942699293DR. AMANDA KAY DERASMI DO
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1861999062DR. JUAN QUERUBIN DO
Individual
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1336573419 SANDRA UNDIS PH.D, L.P.
Individual
Psychologist800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1619604790 SUSAN ARNESON PSYD
Individual
Psychologist800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1093192833 CARLY JO ALEXANDER PSYD
Individual
Psychologist (Clinical)800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1790953685 KORINNE ANN NOVAK NP
Individual
Nurse Practitioner (Adult Health)800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1871290114 SUSAN WANJIKU COVINGTON CNP
Individual
Nurse Practitioner (Family)800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1275577215ALLINA HEALTH SYSTEM
Organization
Physical Medicine & Rehabilitation800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1700625662 LAURA ANN FRY PHD, LP
Individual
Psychologist800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(612) 863-4495
1760002968 SAMUEL JEFFREY MARTIN
Individual
Student in an Organized Health Care Education/Training Program800 E 28TH ST STE 1750
MINNEAPOLIS, MN 55407
(952) 807-5384

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1801422928, enumerated in the NPI registry as an "individual" on March 20, 2020

The provider is located at 800 E 28th St Ste 1750 Minneapolis, Mn 55407 and the phone number is (612) 863-4495

The provider's speciality is Psychologist with taxonomy code 103T00000X

The provider has more than 7 years of experience.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The practitioner is affiliated to the following hospital(s): ABBOTT NORTHWESTERN HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on March 20, 2020. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.