Active NPI
Becka Anne Koll, LSW
- Social Worker
- Mandan, ND
National Provider Identifier
1003370149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 5103
- Practice address
- 200 2ND Ave NW
Mandan, ND 58554-3124 - Phone
- (701) 667-3281
- NPI assigned
- Jan 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 5103 | ND | Primary |
Addresses
Primary practice location
200 2ND Ave NW
Mandan, ND 58554-3124
Mailing address
200 2ND Ave NW
Mandan, ND 58554-3124
Phone (701) 667-3281
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104100000X | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5103 | ND | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morton County Social Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Health Clinic/Center
- Mandan, ND
- NPI 1255742698
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548201600000",
"number": "1003370149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 2ND AVE NW",
"city": "MANDAN",
"state": "ND",
"postal_code": "585543124",
"telephone_number": "701-667-3281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 2ND AVE NW",
"city": "MANDAN",
"state": "ND",
"postal_code": "585543124",
"telephone_number": "701-667-3281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLL",
"first_name": "BECKA",
"middle_name": "ANNE",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-23",
"last_updated": "2019-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ND",
"license": "5103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104100000X",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mandan, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.