Individual provider Active NPI

Amelia Marie Ganyo, M.A.

  • Professional Counselor
  • Crookston, MN
National Provider Identifier
1508219668
Registry record updated Jan 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC02321 Issued in MN
Practice address
603 Bruce St
Crookston, MN 56716-2914
Phone
(218) 281-3940
NPI assigned
Jul 13, 2016
Last updated
Jan 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X CC02321 MN Primary

Addresses

Primary practice location

603 Bruce St
Crookston, MN 56716-2914

Mailing address

PO Box 603
Crookston, MN 56716-0603
Phone (218) 280-2847

Other names 1

  • Amelia Marie Schmitz Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL credibleBH.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231227002009 MN Practitioner - Mental Health Counselor 3577913953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alluma IncGroup PAC ID 6709787609, 23 clinicians

Practice addresses (Care Compare)

603 Bruce St
Crookston, MN 56716-2914
Phone (218) 281-3940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
CC02321MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alluma, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

603 Bruce St
Crookston, MN 56716
Phone (218) 281-3940

1422 Central Ave NE
East Grand Forks, MN 56721
Phone (218) 773-6102

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1508219668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567160603",
            "telephone_number": "218-280-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 BRUCE ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567162914",
            "telephone_number": "218-281-3940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANYO",
        "first_name": "AMELIA",
        "middle_name": "MARIE",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-13",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC02321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "credibleBH.com",
            "affiliation": "N",
            "endpointDescription": "online HIE",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "603 Bruce St",
            "city": "Crookston",
            "state": "MN",
            "country_code": "US",
            "postal_code": "567162914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMELIA",
            "last_name": "SCHMITZ",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Crookston, MN

Sources for this page

Verify at the official NPI Registry.