Active NPI
Erik J Blank
- Clinical Social Worker
- Fort Collins, CO
National Provider Identifier
1093342412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SWC.0000001468
- Practice address
- 4856 Innovation Dr
Fort Collins, CO 80525-5539 - Phone
- (970) 494-4200
- Fax
- (844) 270-1824
- NPI assigned
- Mar 25, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ACD.0002422 | CO | |
| Driver | 172A00000X | |||
| Clinical Social Worker | 1041C0700X | SWC.0000001468 | CO | Primary |
Addresses
Primary practice location
4856 Innovation Dr
Fort Collins, CO 80525-5539
Mailing address
4856 Innovation Dr
Fort Collins, CO 80525-5539
Phone (970) 494-4200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SWC.0000001468 | CO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summitstone Health Partners | Current | Accepting new patients | |
| Summitstone Health Partners | Current | Accepting new patients | |
| Summitstone Health Partners | Past | Accepting new patients | |
| Summitstone Health Partners | Past | Accepting new patients | |
| Longview Behavioral Health | Past | Accepting new patients | |
| Longview Behavioral Health | Past | Accepting new patients | |
| Specialized Alternatives for Families and Youth of Colorado, Inc. | Past | Accepting new patients | |
| Longview Behavioral Health | Past | Accepting new patients | |
| Specialized Alternatives for Families and Youth of Colorado, Inc. | Past | Accepting new patients | |
| Longview Behavioral Health | Past | Accepting new patients |
Locations
4856 Innovation Dr
Ste B
Fort Collins, CO 80525
Phone (970) 397-7815
4856 Innovation Dr
Fort Collins, CO 80525
4102 S Timberline Rd
Fort Collins, CO 80525
Phone (970) 494-5728
Organizations & group practices 10
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fort Collins, CO
- NPI 1821552738
-
- Adult Mental Health Clinic/Center
- Fort Collins, CO
- NPI 1154135861
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fort Collins, CO
- NPI 1164269809
-
- Clinical Medical Laboratory
- Fort Collins, CO
- NPI 1194572545
-
- Professional Counselor
- Fort Collins, CO
- NPI 1700567096
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Fort Collins, CO
- NPI 1992486278
-
- Case Management Agency
- Fort Collins, CO
- NPI 1164929550
-
- Case Management Agency
- Fort Collins, CO
- NPI 1437517752
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fort Collins, CO
- NPI 1023799301
-
- Community/Retail Pharmacy
- Fort Collins, CO
- NPI 1730935222
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741219200000",
"number": "1093342412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4856 INNOVATION DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805255539",
"telephone_number": "970-494-4200",
"fax_number": "844-270-1824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4856 INNOVATION DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805255539",
"telephone_number": "970-494-4200",
"fax_number": "844-270-1824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANK",
"first_name": "ERIK",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-25",
"last_updated": "2025-03-06",
"certification_date": "2025-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "ACD.0002422",
"primary": false
},
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "SWC.0000001468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.