CHERI L BRUNETTI, PhD, LP — NPI 1457316812 (Licensed & Credentialed Clinical Neuropsychologist in ROGERS, MN)

CMS-1500 Box 24J / 33a • NPI

1457316812

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

103G00000X

Licensed & Credentialed Clinical Neuropsychologist

Box 32 Service Location & ZIP+4

21308 JOHN MILLESS DR, SUITE 101B, ROGERS, MN, 55374-4708

✓ 9-Digit EDI 837 ZIP+4 (55374-4708)

Practice Phone & Referral Fax

(763) 428-4060

Fax: (763) 428-1711

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1457316812 (CHERI L BRUNETTI, PhD, LP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1457316812` (NPI-1 Individual Practitioner)
Provider / Legal Name	CHERI L BRUNETTI, PhD, LP
Plain-English Specialty	Licensed & Credentialed Clinical Neuropsychologist NUCC Code: `103G00000X` (Clinical Neuropsychologist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	21308 JOHN MILLESS DR, SUITE 101B, ROGERS, MN, 55374-4708
Practice Telephone / Fax	Tel: (763) 428-4060 \| Fax: (763) 428-1711
Administrative Mailing Address	21308 JOHN MILLESS DR, ROGERS, MN, 55374-4708
Enumeration & Last Sync	Enumerated: 2006-04-19 \| CMS Record Updated: 2009-06-29

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

21308 JOHN MILLESS DR, SUITE 101B, ROGERS, MN, 55374-4708

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Plain-English Taxonomy & CMS Crosswalk (103G00000X)

What Does Taxonomy Code 103G00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103G00000X translates to:
"Licensed & Credentialed Clinical Neuropsychologist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Clinical Neuropsychologist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CHERI L BRUNETTI, PhD, LP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103T00000X` — Psychologist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist	State: MN \| License: `LP4169` \| Primary: Secondary
`103G00000X` — Clinical Neuropsychologist Plain English: Licensed & Credentialed Clinical Neuropsychologist	State: MN \| License: `LP4169` \| Primary: Yes (Primary)
`103TC0700X` — Psychologist, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical	State: MN \| License: `LP4169` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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CHERI L BRUNETTI, PhD, LP (NPI #1457316812)