Active NPI
Jon Mark Fisher, LICSW
- Clinical Social Worker
- Shoreview, MN
National Provider Identifier
1487820643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16234
- Practice address
- 3490 Lexington Ave N
Suite 205
Shoreview, MN 55126-8074 - Phone
- (651) 486-3808
- Fax
- (651) 486-3858
- NPI assigned
- May 7, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 16234 | MN | Primary |
Addresses
Primary practice location
3490 Lexington Ave N
Suite 205
Shoreview, MN 55126-8074
Mailing address
3490 Lexington Ave N
Suite 205
Shoreview, MN 55126-8074
Phone (651) 486-3808
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Youth & Family Services | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community Health Clinic/Center
- White Bear Lake, MN
- NPI 1073098810
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1487820643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3490 LEXINGTON AVE N",
"address_2": "SUITE 205",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551268074",
"telephone_number": "651-486-3808",
"fax_number": "651-486-3858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3490 LEXINGTON AVE N",
"address_2": "SUITE 205",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551268074",
"telephone_number": "651-486-3808",
"fax_number": "651-486-3858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHER",
"first_name": "JON",
"middle_name": "MARK",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-07",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "16234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreview, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.