Individual provider Active NPI

Jeffrey R Stine, LCSW

  • Clinical Social Worker
  • Fargo, ND
National Provider Identifier
1679003594
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5109 Issued in ND
Practice address
6046 14TH St S
Fargo, ND 58104-7340
Phone
(701) 404-0997
Fax
(701) 566-8876
NPI assigned
Jun 13, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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 5109 ND Primary

Addresses

Primary practice location

6046 14TH St S
Fargo, ND 58104-7340

Mailing address

6046 14TH St S
Fargo, ND 58104-7340
Phone (701) 404-0997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20200820001849 ND Practitioner - Clinical Social Worker 7810229994 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6046 14TH St S
Fargo, ND 58104-7340
Phone (701) 404-0997

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5109NDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Above All Counseling PLLC Clinical CurrentSince Feb 1, 2021 Accepting new patients

Locations

2632 47th St S
Ste 102
Fargo, ND 58104
Phone (701) 209-0319

6046 14th St S
Fargo, ND 58104
Phone (701) 471-7092

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.

NPI Registry JSON

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1679003594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6046 14TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047340",
            "telephone_number": "701-404-0997",
            "fax_number": "701-566-8876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6046 14TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047340",
            "telephone_number": "701-404-0997",
            "fax_number": "701-566-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STINE",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-13",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "5109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.