Individual provider Active NPI

Stuart James Popkin, L.I.C.S.W.

  • Clinical Social Worker
  • Brainerd, MN
National Provider Identifier
1386774610
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
07191 Issued in MN
Practice address
520 5TH St. N.W.
Brainerd, MN 56401
Phone
(218) 829-3235
NPI assigned
Mar 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 07191 MN Primary

Addresses

Primary practice location

520 5TH St. N.W.
Brainerd, MN 56401

Mailing address

14068 Hardy Lake Rd SW
Pillager, MN 56473-2227
Phone (218) 820-9993

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
07191MNMDClinical Social Worker
7191MNMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386774610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14068 HARDY LAKE RD SW",
            "city": "PILLAGER",
            "state": "MN",
            "postal_code": "564732227",
            "telephone_number": "218-820-9993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 5TH ST. N.W.",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "56401",
            "telephone_number": "218-829-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPKIN",
        "first_name": "STUART",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "L.I.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "07191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.