Jessica Rae Croatt Niemi, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15124 Issued in MN

Practice address

1426 Bemidji Ave N Ste 1
Bemidji, MN 56601-3882

Phone

(218) 444-2233

Fax

(218) 237-2520

NPI assigned

May 1, 2007

Last updated

Jun 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jessica Rae Croatt Former name

Medicare fee-for-service enrollment

Enrolled in MN

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 1

Specialty

Clinical Social Worker

Education

University of Wisconsin School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Country Associates, Inc.Group PAC ID 3779610472, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Country Associates, Inc.

  • Community/Behavioral Health Agency
  • Park Rapids, MN
  • NPI 1104151588
  Medicare reassignment Care Compare group NPD
• Stellher Human Services, Inc.

  • Community/Behavioral Health Agency
  • Bemidji, MN
  • NPI 1023225430
  NPD (past)
• Peterson Medical Clinics, LLC

  dba Rural Psychiatry Associates

  • Multi-Specialty Clinic/Center
  • Grand Forks, ND
  • NPI 1699295774
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1265653653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 BRIDGE ST",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701210",
            "telephone_number": "218-366-9229",
            "fax_number": "218-237-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1426 BEMIDJI AVE N STE 1",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013882",
            "telephone_number": "218-444-2233",
            "fax_number": "218-237-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROATT NIEMI",
        "first_name": "JESSICA",
        "middle_name": "RAE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD MN",
            "identifier": "201J8NI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "048937900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CROATT",
            "middle_name": "RAE",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Counseling Services of Bemidji Professional Corporation (Counseling Services of Bemidji)
• County of Beltrami
• Cody Lee Coyer, B.S, LADC
• Andrea Olivia Craig, APRN, CNP
• William Randall Crews, ATC
• Morgan Croatt, MSW, LICSW
• Sarah Cronin, PHD, LP
• Michelle Marie Crowson, LADC
• Alyssa Faye Cummings, REGISTERED NURSE
• Ashley Cunderla

• Clinical Social Worker in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.