Individual provider Active NPI

Tiffany Grace Rundquist

  • Clinical Social Worker
  • Bemidji, MN
National Provider Identifier
1285419614
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1705 Anne St NW
Bemidji, MN 56601-6151
Phone
(218) 751-3280
NPI assigned
Aug 24, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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 Primary

Addresses

Primary practice location

1705 Anne St NW
Bemidji, MN 56601-6151

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240311001979 MN Practitioner - Clinical Social Worker 1658717863 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Jan 27, 2024 Accepting new patients

Locations

1705 Anne St NW
#3
Bemidji, MN 56601
Phone (218) 333-2035

1705 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2035

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1692835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1285419614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016151",
            "telephone_number": "218-751-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNDQUIST",
        "first_name": "TIFFANY",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-24",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

Sources for this page

Verify at the official NPI Registry.