Ethen D Sietsema, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3110 Issued in MN

Practice address

2925 Chicago Ave
Minneapolis, MN 55407-1321

Phone

(866) 603-0016

NPI assigned

Jan 3, 2022

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

Electronic endpoints 1

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

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: esietsema363439@excellian.direct.allina.com

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.

• Allina Health System

  • Family Medicine Physician
  • Annandale, MN
  • NPI 1457657249
  Medicare reassignment Care Compare group NPD
• Ridgeview Medical Center

  • Certified Registered Nurse Anesthetist
  • Waconia, MN
  • NPI 1528364429
  Medicare reassignment Care Compare group NPD
• Minnesota Valley Health Center Inc

  • Critical Access Hospital
  • Le Sueur, MN
  • NPI 1730248907
  Medicare reassignment NPD
• Sibley Medical Center

  • Critical Access Hospital
  • Arlington, MN
  • NPI 1740240225
  Medicare reassignment NPD
• Allina Health System

  • Neurological Surgery Physician
  • Minneapolis, MN
  • NPI 1730532631
  NPD
• Allina Health System

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD
• Minnesota Valley Health Center Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Le Sueur, MN
  • NPI 1215097902
  NPD
• Ridgeview Medical Center

  • Urgent Care Clinic/Center
  • Chanhassen, MN
  • NPI 1558142869
  NPD
• Ridgeview Medical Center

  • Diagnostic Radiology Physician
  • Waconia, MN
  • NPI 1811174923
  NPD

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1427719467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "866-603-0016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIETSEMA",
        "first_name": "ETHEN",
        "middle_name": "D",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "3110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "esietsema363439@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "2925 Chicago Ave",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554071321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Olynn Agatha Sieh
• Timothy D Sielaff, MD PHD
• William David Sieling, MD
• Chesney Burgweger Siems, MD
• Daniel Marc Siers, MD
• Paula Sieve, D.C.
• Kelsey Sievers, LGSW
• Tyson Sievers, M.D.
• Kathleen Curtis Sievwright, RPH, BCPS
• Jessalyn Siewert, CNP

• Professional Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.