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
- 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
- Code Navigator
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 HOSPITAL | 800 EAST 28TH STREET MINNEAPOLIS, MN 55407 | (612) 863-4000 | Acute Care Hospitals |
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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. | |||||||||
1 | 8 | 0 | 1 | 4 | 2 | 2 | 9 | 2 | 8 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 8 | 0 | 1 | 8 | 2 | 4 | 9 | 4 | |
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 = 8 | 8 |
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 & Rehabilitation | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1528478625 | DR. ARUN IDICULLA M.D. Individual | Physical Medicine & Rehabilitation | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1336515030 | MR. 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 Practitioner | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1295968790 | LIAT GOLDMAN MD Individual | Physical Medicine & Rehabilitation | 800 E 28TH ST STE 1750 ABBOTT NORTHWESTERN HOSPITAL MINNEAPOLIS, MN 55407 (612) 863-4495 |
1235559147 | ANNE CATHERINE TITA M.D. Individual | Physical Medicine & Rehabilitation | 800 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 |
1568984078 | DR. ANDREW F FEDOR III PHD LP Individual | Psychologist | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1013041540 | DR. INDRA LIM MD Individual | Physical Medicine & Rehabilitation | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1942699293 | DR. AMANDA KAY DERASMI DO Individual | Physical Medicine & Rehabilitation | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1861999062 | DR. JUAN QUERUBIN DO Individual | Physical Medicine & Rehabilitation | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1336573419 | SANDRA UNDIS PH.D, L.P. Individual | Psychologist | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1619604790 | SUSAN ARNESON PSYD Individual | Psychologist | 800 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 |
1275577215 | ALLINA HEALTH SYSTEM Organization | Physical Medicine & Rehabilitation | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1700625662 | LAURA ANN FRY PHD, LP Individual | Psychologist | 800 E 28TH ST STE 1750 MINNEAPOLIS, MN 55407 (612) 863-4495 |
1760002968 | SAMUEL JEFFREY MARTIN Individual | Student in an Organized Health Care Education/Training Program | 800 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].
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