NPIMap

Individual provider Active NPI

Megan Hickenbottom, LICSW

  • Clinical Social Worker
  • Fridley, MN
National Provider Identifier
1093277238
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
22369 Issued in MN
Practice address
520 Osborne Rd NE
Fridley, MN 55432-2718
Phone
(763) 236-7958
NPI assigned
Apr 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 22369 MN Primary

Addresses

Primary practice location

520 Osborne Rd NE
Fridley, MN 55432-2718

Mailing address

3305 Queensland LN N
Plymouth, MN 55447-1133
Phone (612) 720-5632

Other practice location 1

2855 Campus Dr
Plymouth, MN 55441-2649
Phone (763) 577-7000

Other names 1

  • Megan Ness Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190509001660 MN Practitioner - Clinical Social Worker 9234472432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Minnesota, Duluth School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

2855 Campus Dr
Suite 660
Plymouth, MN 55441-2665
Phone (763) 577-7900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Jul 31, 2024 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System PastSince Sep 29, 2024 Accepting new patients

Locations

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2855 Campus Dr
Ste 660
Plymouth, MN 55441
Phone (763) 577-7900

Interoperability endpoints

  • Direct secure messaging: mhickenbottom437307@excellian.direct.allina.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1093277238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 QUEENSLAND LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471133",
            "telephone_number": "612-720-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-7958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2855 Campus Dr",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MN",
            "postal_code": "554412649",
            "country_code": "US",
            "telephone_number": "763-577-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKENBOTTOM",
        "first_name": "MEGAN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-05",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEGAN",
            "last_name": "NESS",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.