Joshua C Koletar, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

30198 Issued in MN

Practice address

2680 Snelling Ave N Ste 200
Roseville, MN 55113-1879

Phone

(651) 364-9381

Fax

(651) 364-9382

NPI assigned

Jan 24, 2022

Last updated

Feb 17, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1386396091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 SNELLING AVE N STE 200",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131879",
            "telephone_number": "651-364-9381",
            "fax_number": "651-364-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 SNELLING AVE N STE 200",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131879",
            "telephone_number": "651-364-9381",
            "fax_number": "651-364-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLETAR",
        "first_name": "JOSHUA",
        "middle_name": "C",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-24",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "30198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher James Knoedler Jr., MD
• John P Knoedler Jr., MD
• Gregory Paul Knudsen, ABOC, NCLE
• Dennis K Kobiri, MD
• Yasemin Koksel, MD
• Ian Koltes, LADC
• Paul Yeej Kong, CMT, LMT
• Julie Ann Konop, D.D.S.
• Jeffrey Korolchuk Jr., L.M.T.
• Mark Daniel Kovacs, MD

• Clinical Social Worker in Roseville, MN
• Providers in Roseville, 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 Feb 17, 2025; 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.