Kimberly Jean Sletta Avenson, MSW, LICSW
Individual provider Active NPI Clinical Social Worker · Bemidji, MN
NPI 1154422012 · NPPES record last updated Dec 13, 2019
Key facts
- NPI
- 1154422012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 15400 (MN)
- Practice address
- 722 15TH Street N.W.
Bemidji, MN 56619-0640 - Phone
- (218) 751-3280
- Fax
- (218) 751-3298
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 22
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Sanford Health of Northern Minnesota
Practice addresses (Care Compare)
1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000
1705 Anne St NW
Bemidji, MN 56601-6151
Phone (218) 333-5000
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.56 of 100
- Quality
- 74.25
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.16
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050912000983 | MN | Practitioner - Clinical Social Worker | 3779516661 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15400 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Health of Northern Minnesota | Current |
Accepting new patients | |
| Sanford Health of Northern Minnesota | Current |
Accepting new patients | |
| Sanford Health of Northern Minnesota | Current | Accepting new patients |
Locations
1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 15400 | MN | Yes |
Addresses
Primary practice location
722 15TH Street N.W.
Bemidji, MN 56619-0640
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 153485800 | Medicaid | MN |
Other providers in Bemidji, MN
- Associated Drug Inc
- Jonas Attilus
- Aurora Waasakone Community of Learners
- Autumn Hills of Bemidji, Inc.
- Autumn Hills of Bemidji, Inc.
- Ethan Axtman
- Tiffany Alicia Axtman
- Alexandra Patricia Bader
- Sanggyu Bae
- Bonnie Margaret Bailey
All providers in Bemidji, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.