Bruce Keith Thordal, PHD
NPI 1417091455ActiveIndividual· Psychologist, Cognitive & Behavioral· Eagan, MN
Psychologist, Cognitive & Behavioral (PHD) in Eagan, Minnesota, licensed in MN, with an NPI issued in February 2007. Medicare paid $21,453 for services to 19 patients in 2024.
Overview
| NPI | 1417091455 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHD |
| Sole proprietor | Yes |
| NPI issued | Feb 15, 2007 |
| Last updated in NPPES | Jul 8, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Cognitive & Behavioral Primary | 103TB0200X | LP1135 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 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 | 19 |
|---|---|
| Services billed | 332 across 2 procedure codes |
| Paid by Medicare | $21,453 |
Education and affiliations
| Graduation year | 1975 |
|---|---|
| Medicare specialty | Clinical Psychologist |