Active NPI
Gordon Eckroth, LICSW/BCD
- Case Manager/Care Coordinator
- Bismarck, ND
National Provider Identifier
1386672442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1237 W Divide Ave
Ste 5
Bismarck, ND 58501-1208 - Phone
- (701) 328-8867
- Fax
- (701) 328-8900
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0186 | ND | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
1237 W Divide Ave
Ste 5
Bismarck, ND 58501-1208
Mailing address
1237 W Divide Ave
Ste 5
Bismarck, ND 58501-1208
Phone (701) 328-8867
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05382 | Other | BCBS OF ND | |
| N5382 | Other | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0186 | ND | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376524800000",
"number": "1386672442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1237 W DIVIDE AVE",
"address_2": "STE 5",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585011208",
"telephone_number": "701-328-8867",
"fax_number": "701-328-8900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1237 W DIVIDE AVE",
"address_2": "STE 5",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585011208",
"telephone_number": "701-328-8867",
"fax_number": "701-328-8900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECKROTH",
"first_name": "GORDON",
"credential": "LICSW/BCD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2013-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ND",
"license": "0186",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ND",
"identifier": "05382",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "N5382",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.