Clay County

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

Legal business name

CLAY COUNTY

Doing business as

Clay County Public Health

Practice address

715 11TH St N
Ste 303
Moorhead, MN 56560-2083

Phone

(218) 299-7301

Fax

(218) 299-5795

NPI assigned

Apr 13, 2007

Last updated

Jan 3, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lori J Johnson

Title

Clay County Auditor

Phone

(218) 299-5262

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Clay County Public Health Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica L Mickelson, LSW

  • Case Manager/Care Coordinator
  • Fargo, ND
  • NPI 1801956255
  NPD

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1114142569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 11TH ST N STE 303",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602083",
            "telephone_number": "218-299-7301",
            "fax_number": "218-299-5195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 11TH ST N",
            "address_2": "STE 303",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602083",
            "telephone_number": "218-299-7301",
            "fax_number": "218-299-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLAY COUNTY AUDITOR",
        "authorized_official_telephone_number": "218-299-5262"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PMAP PROVIDER",
            "identifier": "8300104",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427753800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS DETOX PROVIDER",
            "identifier": "4C45CL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA UBH PROVIDER",
            "identifier": "5060753",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS PROVIDER ID",
            "identifier": "8G510CL",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clay County Public Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Mehl Midwifery LLC
• Christopher M Mathison DDS PC
• Andrew J Clark, DPT
• Brian Clark
• Ivory Clark
• Clay County Social Services
• Clay Moorhead Holdings LLC (Moorhead Restorative Care Center)
• Coborns Inc (Cash Wise Pharmacy)
• Elizabeth Cogan
• Aaron Coleman, LPC

• Community Health Registered Nurse in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Community Health Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.