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COURTNEY LEE TATE RD
NPI 1164014122
Dietitian, Registered in Minneapolis, MN

Active since February 10, 2021
5354 PARKDALE DR, MINNEAPOLIS, MN 55416(888) 364-5977 Get Directions Write a Review

NPPES record last updated: February 10, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Courtney Lee Tate Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COURTNEY LEE TATE RD (NPI 1164014122) is an individual dietitian, registered in Minneapolis, Minnesota, licensed in Minnesota (86118704) and active in the NPI registry since February 2021.

NPPES Registry Identity

NPI1164014122
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameCOURTNEY LEE TATECredential: RD
Location Address5354 PARKDALE DRMinneapolis, MN 55416-1603
Mailing Address5354 Parkdale DrMinneapolis, MN 55416-1603 · (888) 364-5977
Phone(888) 364-5977
Sole ProprietorNo
Enumeration DateFebruary 10, 2021
NPPES CertifiedFebruary 10, 2021
✔ NPI 1164014122 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in MN · 86118704
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
5354 PARKDALE DR, Minneapolis, MN 55416
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Courtney Lee Tate Rd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Courtney Tate reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Emily Program P C
7.6 mi
Mental Health (Including Community Mental Health Center)
2265 COMO AVENUE, SUITE 100
St Paul, MN 55108
  • Reassigned Medicare billing, Minnesota enrollment
  • 121 clinicians in this Medicare group
NPI 1528165065 (866) 364-5977

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHANIA VAUPEL
Counselor (Professional)
5354 PARKDALE DR
ST LOUIS PARK, MN 55416
Hennepin County (888) 364-5977
KENNEDY HANEY-GOELZ MS RDN LD
Dietitian, Registered
5354 PARKDALE DR
MINNEAPOLIS, MN 55416
Hennepin County (888) 364-5977
JENNIE LASKOW LPCC
Counselor (Professional)
5354 PARKDALE DR, SUITE 200
ST LOUIS PARK, MN 55416
Hennepin County (651) 645-5323
EMILY JOYCE DAHLE LICSW
Social Worker (Clinical)
5354 PARKDALE DR
MINNEAPOLIS, MN 55416
Hennepin County (866) 821-0281
OLIVIA RICELLI MS, RD, LD
Dietitian, Registered
5354 PARKDALE DR
MINNEAPOLIS, MN 55416
Hennepin County (888) 364-5977
ADDISON REIMER MS, RD
Dietitian, Registered
5354 PARKDALE DR
MINNEAPOLIS, MN 55416
Hennepin County (440) 670-6700
MS. CODY L GRANDA M.S., LMFT
Marriage & Family Therapist
5354 PARKDALE DR, SECOND FLOOR
MINNEAPOLIS, MN 55416
Hennepin County (651) 645-5323
AMRA BUDIMLIC
Social Worker (Clinical)
5354 PARKDALE DR
MINNEAPOLIS, MN 55416
Hennepin County (651) 645-5323

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Courtney Tate's NPI number?

The NPI number for Courtney Tate is 1164014122. It was assigned to this individual provider in the NPPES registry on February 10, 2021.

Where is Courtney Tate located?

Courtney Tate practices at 5354 Parkdale Dr, Minneapolis, MN 55416. The listed phone number is (888) 364-5977.

What is Courtney Tate's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Courtney Tate enrolled in Medicare?

Yes. Courtney Tate is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Courtney Tate's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Courtney Tate reassigns Medicare benefits to Emily Program P C (St Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Courtney Tate's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Courtney Tate was last updated on February 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.