Individual provider Active NPI

Skyler Martin, MSW, LCSW, CRADC

  • Clinical Social Worker
  • Grand Forks, ND
National Provider Identifier
1093497455
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2025044499 Issued in MO
Practice address
3674 S Washington St
Grand Forks, ND 58201-5766
Phone
(701) 205-3000
Fax
(701) 732-2501
NPI assigned
Aug 4, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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 2025044499 MO Primary

Addresses

Primary practice location

3674 S Washington St
Grand Forks, ND 58201-5766

Mailing address

PO Box 5210
Grand Forks, ND 58206-5210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, AK, MN, ND4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20260506003333 MO Practitioner - Clinical Social Worker 7416425574 Reassigns benefits to 1 organization
I20260514000610 AK Practitioner - Clinical Social Worker 7416425574 Reassigns benefits to 3 organizations
I20260526002913 MN Practitioner - Clinical Social Worker 7416425574 Reassigns benefits to 1 organization
I20260618003606 ND Practitioner - Clinical Social Worker 7416425574 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peterson Medical Clinics LLCGroup PAC ID 9335412220, 91 clinicians

Practice addresses (Care Compare)

Saint Louis, MO 63123
Phone (701) 205-3000

205 E Benson Blvd
Suite 401
Anchorage, AK 99503-4019
Phone (701) 205-3000

3674 S Washington St
Grand Forks, ND 58201-5766
Phone (701) 205-3000

519 Anne St NW
Suite a
Bemidji, MN 56601-4277
Phone (701) 205-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025044499MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Peterson Medical Clinics, LLC CurrentSince Mar 30, 2026 Accepting new patients

Locations

205 E Benson Blvd
Ste 401
Anchorage, AK 99503

519 Anne St NW
Ste A
Bemidji, MN 56601
Phone (218) 444-5700

4501 15th Ave SW
Ste 105
Fargo, ND 58103

3674 S Washington St
Grand Forks, ND 58201
Phone (701) 732-2538

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.

NPI Registry JSON

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

{
    "created_epoch": "1691107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1093497455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5210",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582065210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3674 S WASHINGTON ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015766",
            "telephone_number": "701-205-3000",
            "fax_number": "701-732-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SKYLER",
        "credential": "MSW, LCSW, CRADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-04",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2025044499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.