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Deactivated NPI 1346676897 Deactivated / Inactive NPI Female Practitioner

Dr. Lisa Joyce Keller Salvaggio , PsyD, LP

Psychologist • Thief River Falls, MN

✓ Accepts Medicare Assignment
⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Lisa Keller Salvaggio has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 16, 2013
NPI Deactivation Date September 07, 2023
Total Practice Duration ~26 Years of Practice (1997 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Lisa Keller Salvaggio, PsyD, LP was a registered Psychologist practicing in Thief River Falls, MN. Throughout an active medical career spanning 26 years, Dr. Keller Salvaggio provided care at the practice location at 120 LABREE AVE S until profile deactivation on 2023-09-07.

Dr. Keller Salvaggio was affiliated with Sanford Health Network North and accepted Medicare assignment.

Historical Medicare Part B clinical services included psychotherapy, group psychotherapy. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

120 Labree Ave S

Thief River Falls, MN 567012819

Telephone 2186834349
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

Other

Graduation Year

1997

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist in Thief River Falls, MN

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
29 Yrs +7.0 yrs vs City Avg
City Avg: 22.0 Yrs
State Avg: 22.6 Yrs
Regional Practice Density
11 Specialists

Practicing in Thief River Falls, MN (1833 Statewide)

Telehealth Adoption Rate
27.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
59.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Keller Salvaggio (29 Years) 29 Yrs
Thief River Falls Specialty Average (22.0 Years) 22.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2021)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
90832 Psychotherapy, 30 minutes
67 17 $180.09 $68.52
90853 Group psychotherapy
59 19 $72.83 $23.94
90834 Psychotherapy, 45 minutes
19 12 $193.42 $90.29

Medical Specialties & State Licenses

CMS Verified: 2024-11-04
Psychologist Primary Specialty

NUCC Taxonomy Code: 103T00000X

State License MN LP6349

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Enrollment Part B
H400917182 (MN)

Hospital & Practice Group Affiliations

Sanford Health Network North

1720 Hwy 59 S, Thief River Falls, MN 567014331

Phone: 2186814747

Sanford Health Network North

120 Labree Ave S, Thief River Falls, MN 567012819

Phone: 2186834349

Secondary Practice Locations

3615 17th St S

Moorhead, MN 565607050

Phone: 7017207222

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Dawn Ellis , LICSW, LADC

Counselor - Professional

NPI 1790275196

Licensed Independent Clinical Social Worker, Licensed Alcohol and Drug Counselor

Angela Hiebsch

Counselor - Professional

NPI 1992239628

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

30 Historical Events
📍
Updated Practice Location November 04, 2024

Registered at 120 LABREE AVE S, THIEF RIVER FALLS, MN 567012819 (Tel: 2186834349)

📍
Updated Business Mailing Address November 04, 2024

Registered at PO BOX 5074, SIOUX FALLS, SD 571175074

👤
Provider Name / Credentials Updated November 04, 2024

Recorded as LISA KELLER SALVAGGIO, PSY.D., LP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 09, 2024

Psychologist (License #LP6349 in MN)

📍
Updated Practice Location November 08, 2023

Registered at 3505 8TH ST S STE 3, MOORHEAD, MN 565605108 (Tel: 7015320991)

📍
Updated Practice Location September 21, 2023

Registered at 4342 15TH AVE S STE 103, FARGO, ND 581031125 (Tel: 7015320991)

📍
Updated Business Mailing Address September 21, 2023

Registered at 3505 8TH ST S STE 3, MOORHEAD, MN 565605108 (Tel: 7015320991)

👤
Provider Name / Credentials Updated September 21, 2023

Recorded as LISA KELLER, PSY.D., LP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 21, 2023

Counselor (License #9291217300 in ND)

⚠️
NPI Profile Deactivated September 07, 2023

Record deactivated on September 07, 2023

📍
Updated Business Mailing Address August 23, 2022

Registered at 600 22ND AVE NW STE 4, MINOT, ND 587030986 (Tel: 7018521180)

👤
Provider Name / Credentials Updated August 23, 2022

Recorded as LISA KELLER, PSY.D., LP

📍
Updated Practice Location March 29, 2022

Registered at 600 22ND AVE NW STE B2, MINOT, ND 587030986 (Tel: 7018521180)

📍
Updated Business Mailing Address March 29, 2022

Registered at 600 22ND AVE NW STE B2, MINOT, ND 587030986 (Tel: 7018521180)

👤
Provider Name / Credentials Updated March 29, 2022

Recorded as LISA KELLER SCHAFER, PSY.D., LP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 29, 2022

Counselor (License #9291217300 in ND)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 05, 2019

Counselor (License #CC00782 in MN)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Psychologist (License #782 in MN)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 06, 2018

Psychologist (License #782 in MN)

NPI Profile Active May 16, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location May 16, 2017

Registered at 120 LABREE AVE S, THIEF RIVER FALLS, MN 567012819 (Tel: (218) 683-4333)

📍
Updated Business Mailing Address May 16, 2017

Registered at 120 LABREE AVE S, THIEF RIVER FALLS, MN 567012819 (Tel: (218) 683-4333)

👤
Provider Name / Credentials Updated May 16, 2017

Recorded as LISA KELLER SCHAFER, PSY.D., LPCC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 16, 2017

Counselor (License #CC00782 in MN)

NPI Profile Active February 06, 2015

NPI status registered as active in NPPES database

📍
Updated Practice Location February 06, 2015

Registered at 1058 COLLEGE DR, NEW TOWN, ND 587639112 (Tel: 7016277777)

📍
Updated Business Mailing Address February 06, 2015

Registered at 1058 COLLEGE DR, NEW TOWN, ND 587639112 (Tel: 7016277777)

👤
Provider Name / Credentials Updated February 06, 2015

Recorded as LISA KELLER SCHAFER, PSY.D., LPCC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 06, 2015

Counselor (License #CC00782 in MN)

🟢
Initial NPI Registration & Enumeration September 16, 2013

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1346676897
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 16, 2013
Last Update: November 04, 2024
Deactivation Date: September 07, 2023
Sole Proprietor: No

Mailing Address

Po Box 5074

Sioux Falls, SD 571175074

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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