Keith Wayne Fridel, PHD
NPI 1215345244ActiveIndividual· Psychologist· Shakopee, MN
Psychologist (PHD) with Park Nicollet Clinic, practicing in Shakopee, Minnesota. Medicare paid $7,707 for services to 69 patients in 2024.
Overview
| NPI | 1215345244 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHD |
| Sole proprietor | No |
| NPI issued | Jul 22, 2014 |
| Last updated in NPPES | Mar 17, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | 071008852 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (MN) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 69 |
|---|---|
| Services billed | 89 across 2 procedure codes |
| Paid by Medicare | $7,707 |
Education and affiliations
| Graduation year | 2011 |
|---|---|
| Medicare specialty | Clinical Psychologist |
| Telehealth | Offers telehealth |
Medical group
- Park Nicollet ClinicSt Louis Park, MN · 1,787 clinicians
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