Kendra Porter, MA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

02638 Issued in MN

Practice address

1200 S Pokegama Ave Ste 160
Grand Rapids, MN 55744-4296

Phone

(218) 999-0051

Fax

(218) 999-7020

NPI assigned

Jun 6, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, 2020

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

Credentials

Master of Arts

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

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188

  MN

  Medicare reassignment Care Compare group NPD
• Compass North Psychological Services Inc

  • Community/Behavioral Health Agency
  • Grand Rapids, MN
  • NPI 1437622453
  NPD
• Providence Psychiatry Services, LTD.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Rapids, MN
  • NPI 1871942953
  NPD

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1598494635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S POKEGAMA AVE STE 160",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444296",
            "telephone_number": "218-999-0051",
            "fax_number": "218-999-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S POKEGAMA AVE STE 160",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444296",
            "telephone_number": "218-999-0051",
            "fax_number": "218-999-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KENDRA",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "02638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Clyde Pliscott, PHARMD
• Marla Jacqueline Pogorelc, MSW, LICSW
• Pokegama Dental
• Pokegama Physical Therapy Consultants, LLC
• Pokegama Physical Therapy, LLC
• Beth M Prewett
• Progressive Care, LLC
• Providence Psychiatry Services, LTD.
• Richard Puckett, LPMED
• Amanda Puttonen

• All providers in Grand Rapids, MN
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.