Kurt David Holm, LICSW, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27249 Issued in MN

Practice address

13045 Falcon Dr Ste 100
Baxter, MN 56425-4201

Phone

(218) 829-9307

NPI assigned

Jun 8, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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, 2018

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

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 and National Provider Directory roles.

• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

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

  • Substance Abuse Rehabilitation Facility
  • Perham, MN
  • NPI 1801209697
  NPD (past) Authorized official
• Northern Pines Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Brainerd, MN
  • NPI 1225168602
  NPD (past)
• Rewind, Inc.

  • Substance Abuse Rehabilitation Facility
  • Perham, MN
  • NPI 1568678639
  NPD (past)

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

{
    "created_epoch": "1402185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1396158358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13045 FALCON DR STE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564254201",
            "telephone_number": "218-829-9307",
            "fax_number": "218-829-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13045 FALCON DR STE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564254201",
            "telephone_number": "218-829-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLM",
        "first_name": "KURT",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LICSW, LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-08",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302032",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED INDEPENDENT CLINICAL SOCIAL WORKER",
            "identifier": "27249",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC LICENSE",
            "identifier": "302032",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron John Hokanson, D.C.
• Ryan Jon Hokanson, DC
• Holbrook Family Chiropractic PLLC (Family Chiropractic Clinic and Physical Therapy)
• Joshua Allen Holbrook, D.C.
• Thomas Holbrook
• Kayla Marie Holtan
• Susanne Ethel Holtquist, MSW, LICSW
• Shayla Rae Holtz
• Home Care Oxygen Service Inc (Specialty Home Med)
• Alexandra Hoopman

• Clinical Social Worker in Baxter, MN
• Providers in Baxter, 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 12, 2021; 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.