Individual provider Active NPI

Kassandra Nicole Placencio

  • Clinical Social Worker
  • Grand Forks, ND
National Provider Identifier
1629952858
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
3674 S Washington St
Grand Forks, ND 58201
Phone
(701) 732-2538
Fax
(701) 732-2501
NPI assigned
Aug 1, 2025
Last updated
Aug 1, 2025By the provider in NPPES
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

3674 S Washington St
Grand Forks, ND 58201

Mailing address

PO Box 5210
Grand Forks, ND 58206-5210
Phone (701) 205-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, MN, ND, TX4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20250922001419 AK Practitioner - Clinical Social Worker 8729582762 Reassigns benefits to 3 organizations
I20251010003235 MN Practitioner - Clinical Social Worker 8729582762 Reassigns benefits to 1 organization
I20251030004065 ND Practitioner - Clinical Social Worker 8729582762 Reassigns benefits to 1 organization
I20260101000170 TX Practitioner - Clinical Social Worker 8729582762 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peterson Medical Clinics LLCGroup PAC ID 9335412220, 91 clinicians

Practice addresses (Care Compare)

205 E Benson Blvd
Suite 401
Anchorage, AK 99503-4019
Phone (701) 205-3000

3674 S Washington St
Grand Forks, ND 58201-5766
Phone (701) 205-3000

519 Anne St NW
Suite a
Bemidji, MN 56601-4277
Phone (701) 205-3000

859 Pine More Dr
Brownsville, TX 78526-4276
Phone (701) 205-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35443MNMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Aleutian Tribes, Inc. CurrentSince Jan 23, 2026 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Norton Sound Health Corporation CurrentSince Sep 5, 2025 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corportion Current Accepting new patients
Norton Sound Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Norton Sound Health Corporation CurrentSince Sep 5, 2025 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Peterson Medical Clinics, LLC CurrentSince Sep 5, 2025 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Dec 19, 2025 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Eastern Aleutian Tribes, Inc CurrentSince Jan 23, 2026 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corportation Current Accepting new patients
Bristol Bay Area Health Corportion Current Accepting new patients

Locations

205 E Benson Blvd
Ste 401
Anchorage, AK 99503

3380 C St
Ste 107
Anchorage, AK 99503
Phone (907) 277-1440

519 Anne St NW
Ste A
Bemidji, MN 56601
Phone (218) 444-5700

4501 15th Ave SW
Ste 105
Fargo, ND 58103

3674 S Washington St
Grand Forks, ND 58201
Phone (701) 732-2538

Organizations & group practices 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1754006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1629952858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5210",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582065210",
            "telephone_number": "701-205-3000",
            "fax_number": "701-732-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3674 S WASHINGTON ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-732-2538",
            "fax_number": "701-732-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLACENCIO",
        "first_name": "KASSANDRA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-08-01",
        "last_updated": "2025-08-01",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.