Individual provider Active NPI

Andrina Lee Brantley, LCSWA

  • Clinical Social Worker
  • Grand Forks, ND
National Provider Identifier
1104564293
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C017280 Issued in NC
Practice address
3674 S Washington St
Grand Forks, ND 58201-5766
Phone
(701) 205-3000
Fax
(701) 732-2501
NPI assigned
May 26, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 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 C017280 NC Primary

Addresses

Primary practice location

3674 S Washington St
Grand Forks, ND 58201-5766

Mailing address

PO Box 5210
Grand Forks, ND 58206-5210
Phone (701) 205-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, AK, ND, NC, MT, SD, TX7 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 7

Enrollment IDStateProvider typePAC IDDetails
I20250113001634 MN Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 1 organization
I20250116001111 AK Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 3 organizations
I20250219002302 ND Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 1 organization
I20250310003035 NC Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 1 organization
I20250325001832 MT Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 1 organization
I20250623002201 SD Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 1 organization
I20250905001420 TX Practitioner - Clinical Social Worker 7416485859 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34248MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Peterson Medical Clinics, LLC CurrentSince Jan 1, 2025 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Sep 1, 2025 Accepting new patients
Norton Sound Health Corporation CurrentSince Jan 10, 2025 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corportion Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corportion Current Accepting new patients
Norton Sound Health Corporation CurrentSince Jan 10, 2025 Accepting new patients
Norton Sound Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Sep 1, 2025 Accepting new patients
Bristol Bay Area Health Corportation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Past Accepting new patients
Sweet Memorial Nursing Home PastSince Feb 1, 2010 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

960 S 24th St W
Ste H
Billings, MT 59102
Phone (406) 272-2376

4501 15th Ave SW
Ste 105
Fargo, ND 58103

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

2001 Broadway Ave
Yankton, SD 57078
Phone (605) 520-0477

Interoperability endpoints

  • Direct secure messaging: dreamprovidercareservicesinc.andrinaleebrantley@158148.advancedmd-direct.com

Organizations & group practices 27

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.

View all 27

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peterson Medical Clinics LLC 91 clinicians

Practice addresses (Care Compare)

Belews Creek, NC 27009
Phone (701) 205-3000

New Bern, NC 28562
Phone (701) 205-3000

2001 Broadway Ave
Yankton, SD 57078-2032
Phone (701) 205-3000

3674 S Washington St
Grand Forks, ND 58201-5766

4501 15TH Ave SW
Suite 105
Fargo, ND 58103-8956
Phone (701) 205-3000

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

960 S 24TH St W
Suite H
Billings, MT 59102-6450
Phone (701) 205-3000

NPI Registry JSON

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1104564293",
    "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",
            "telephone_number": "701-205-3000",
            "fax_number": "701-732-2501"
        },
        {
            "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": "BRANTLEY",
        "first_name": "ANDRINA",
        "middle_name": "LEE",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-26",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C017280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.