Jessica Fanberg

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18522 Issued in MN

Practice address

3833 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-2599

Phone

(763) 767-3350

Fax

(763) 747-0912

NPI assigned

Nov 16, 2015

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

Other names 1

• Jessica Gingery Former name

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

Clinical Social Worker

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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
• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)

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

{
    "created_epoch": "1447632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447632000000",
    "number": "1679947543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332599",
            "telephone_number": "763-767-3350",
            "fax_number": "763-747-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332599",
            "telephone_number": "763-767-3350",
            "fax_number": "763-747-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANBERG",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-16",
        "last_updated": "2015-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "18522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GINGERY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Family Based Therapy Associates
• Family Foot and Ankle Clinic, PA
• Family Friendly Chiropractic, Inc.
• Family Life Mental Health Center
• Family Strengths Counseling Group, LLC
• Autumn E. S. R. Fancher, LPCC
• Deka Farah
• Daniel McGeary Farber, MD
• Daniel John Farnham, CRNA
• Oladepo Collins Fasoranti, MBBS

• All providers in Coon Rapids, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; 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.