Individual provider Active NPI

Mai Ko Xiong, LICSW

  • Social Worker
  • Saint Paul, MN
National Provider Identifier
1033986534
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
28589 Issued in MN
Practice address
539 Gotzian St
Saint Paul, MN 55106-5333
Phone
(651) 792-6564
NPI assigned
Dec 6, 2023
Last updated
Dec 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 28589 MN Primary

Addresses

Primary practice location

539 Gotzian St
Saint Paul, MN 55106-5333

Mailing address

593 Gotzian St
Saint Paul, MN 55106-5347

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240129001833 MN Practitioner - Clinical Social Worker 1850744665 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Well-Being Mental Health and Consulting Services LLCGroup PAC ID 1355851387, 2 clinicians

Practice addresses (Care Compare)

1973 Sloan PL
Suite 50B
Saint Paul, MN 55117-2173
Phone (651) 792-6564

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Medical and Rehabilitative Services, LLC CurrentSince Dec 1, 2023 Accepting new patients
Well-Being Mental Health and Consulting Services, LLC CurrentSince May 7, 2025 Accepting new patients
Better Life Inc CurrentSince Dec 1, 2025 Accepting new patients

Locations

4444 W 76th St
Ste 500
Minneapolis, MN 55435
Phone (952) 831-7246

1973 Sloan Pl
Ste 50B
Saint Paul, MN 55117
Phone (651) 214-4605

2147 University Ave W
Ste 204
Saint Paul, MN 55114
Phone (651) 792-6564

2147 University Ave W
Ste 205
Saint Paul, MN 55114
Phone (651) 370-2058

225 University Ave W
Ste 122
Saint Paul, MN 55103
Phone (651) 525-6169

4201 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 564-3880

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1033986534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 GOTZIAN ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551065347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 GOTZIAN ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551065333",
            "telephone_number": "651-792-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XIONG",
        "first_name": "MAI KO",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "28589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.