JAN TYSON ROBERTS PH.D.
NPI 1265724561
Psychologist - Clinical in St Louis Park, MN

Q: What is Jan Tyson Roberts's NPI number?

The NPI number for Jan Tyson Roberts is 1265724561. It was assigned to this individual provider in the NPPES registry on May 5, 2011.

Q: What is Jan Tyson Roberts's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Jan Tyson Roberts was last updated on January 10, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.

Active since May 05, 2011PECOS EnrolledAccepts Medicare Assignment

5353 GAMBLE DR STE 395, ST LOUIS PARK, MN 55416(612) 367-7103(952) 925-5972 Get Directions Write a Review

NPPES record last updated: January 10, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Jan Tyson Roberts Ph.d. NPPES

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

JAN TYSON ROBERTS PH.D. (NPI 1265724561) is an individual clinical provider in St Louis Park, Minnesota, licensed in Minnesota (5330) and active in the NPI registry since May 2011. She is enrolled in Medicare PECOS and is a graduate of Other (2006).

NPPES Registry Identity

NPI1265724561

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameJAN TYSON ROBERTSCredential: PH.D.

Location Address5353 GAMBLE DR STE 395St Louis Park, MN 55416-1510

Mailing Address5353 Gamble Dr Ste 395St Louis Park, MN 55416-1510 · (612) 367-7103 · Fax (952) 925-5972

Phone(612) 367-7103

Fax(952) 925-5972

Sole ProprietorYes

Medical School CMSOtherGraduated 2006

Enumeration DateMay 5, 2011

Last NPPES UpdateJanuary 10, 2018

✔ NPI 1265724561 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MN · 5330

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

5353 GAMBLE DR STE 395, St Louis Park, MN 55416

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jan Tyson Roberts Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254500812

PECOS Enrollment IDI20110816000635

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55416 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$168.28 typical visit price

range $56.00 – $168.28

Typical copayment $42.07 (range $14.00 – $42.07)

Most-billed visit code 99205

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

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

DR. ADEYA RICHMOND PHD, LP

Psychologist (Clinical)