Individual provider Active NPI

Andrew Mackey

  • Clinical Social Worker
  • Saint Cloud, MN
National Provider Identifier
1598208308
Registry record updated May 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
24089 Issued in MN
Practice address
3701 12TH St N
Suite 203
Saint Cloud, MN 56303-2255
Phone
(320) 253-3512
NPI assigned
Nov 28, 2016
Last updated
May 11, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 11, 2018

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
Clinical Social Worker 1041C0700X 24089 MN Primary

Addresses

Primary practice location

3701 12TH St N
Suite 203
Saint Cloud, MN 56303-2255

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 628-9566

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
I20180604001768 MN Practitioner - Clinical Social Worker 6709141260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
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)

101 Dehler Dr
Sartell, MN 56377-4407
Phone (320) 253-3512

1900 Silver Lake NWRD
Suite 110
New Brighton, MN 55112-1789

1900 Silver Lake Rd NW
New Brighton, MN 55112-1789
Phone (651) 628-9566

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD Clinical CurrentSince Apr 16, 2018 Accepting new patients
Family Support Services Inc. Mental Health PastSince May 30, 2023 Accepting new patients

Locations

1714 Bunker Lake Blvd NW
Ste 108
Andover, MN 55304
Phone (763) 330-2830

114 Main St N
Ste 201B
Hutchinson, MN 55350
Phone (320) 753-0778

9245 Quantrelle Ave NE
Otsego, MN 55330
Phone (763) 308-8619

3701 12th St N
Ste 203
Saint Cloud, MN 56303
Phone (218) 631-5993

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

101 Dehler Dr
Sartell, MN 56377
Phone (320) 253-3512

Organizations & group practices 2

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": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525996800000",
    "number": "1598208308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N",
            "address_2": "SUITE 203",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032255",
            "telephone_number": "320-253-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKEY",
        "first_name": "ANDREW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-28",
        "last_updated": "2018-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "24089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.