NPIMap

Individual provider Active NPI

Jody Ann Kirchner, MSW LICSW

  • Social Worker
  • St Cloud, MN
National Provider Identifier
1174566368
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
10908 Issued in MN
Practice address
1406 6TH Avenue North
St Cloud Hospital
St Cloud, MN 56303-1901
Phone
(320) 251-2700
Fax
(320) 656-7115
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 10908 MN Primary

Addresses

Primary practice location

1406 6TH Avenue North
St Cloud Hospital
St Cloud, MN 56303-1901

Mailing address

1406 6TH Avenue North
St Cloud Hospital
St Cloud, MN 56303-1901
Phone (320) 251-2700

Other identifiers 7

IdentifierTypeStateIssuer
136782C851OtherUCARE
6252030OtherMEDICA
352192300MedicaidMN
HP39294OtherHEALTH PARTNERS
218727OtherOPTUM
68G64K1OtherBCBS
922241034347OtherPREFERRED ONE

Other names 1

  • Ms. Jody Ann Mareck Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080805000844 MN Practitioner - Clinical Social Worker 0547334781 Reassigns benefits to 2 organizations
Practice locations: St Cloud, MN

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1555 Northway Dr
100 Centra Care Clinic Northway Family
St Cloud, MN 56303-1258
Phone (320) 251-1775

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10908MNMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Apr 10, 2017 Accepting new patients
Centracare Clinic CurrentSince Apr 10, 2017 Accepting new patients
St. Cloud Hospital Current Accepting new patients
St. Cloud Hospital CurrentSince Apr 10, 2017 Accepting new patients
St. Cloud Hospital Current Accepting new patients
St. Cloud Hospital CurrentSince Apr 10, 2017 Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

12800 Rolling Ridge Rd
Becker, MN 55308
Phone (763) 261-7000

715 1st St N
Cold Spring, MN 56320
Phone (320) 685-3693

1555 Northway Dr
Ste 100
Saint Cloud, MN 56303
Phone (320) 240-3114

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

1555 Northway Dr
#H
Saint Cloud, MN 56303
Phone (320) 240-3157

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Organizations & group practices 7

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1174566368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVENUE NORTH",
            "address_2": "ST CLOUD HOSPITAL",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563031901",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVENUE NORTH",
            "address_2": "ST CLOUD HOSPITAL",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563031901",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRCHNER",
        "first_name": "JODY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MSW LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "10908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "136782C851",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6252030",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "352192300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP39294",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM",
            "identifier": "218727",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "68G64K1",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "922241034347",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODY",
            "last_name": "MARECK",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Cloud, MN

Sources for this page

Verify at the official NPI Registry.