Individual provider Active NPI

Rebekah J Elling, MSW, LICSW

  • Clinical Social Worker
  • Minneapolis, MN
National Provider Identifier
1700391034
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
19347 Issued in MN
Practice address
3100 W Lake St Ste 210
Minneapolis, MN 55416-4597
Phone
(612) 925-6033
Fax
(612) 925-8496
NPI assigned
Dec 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2017

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 19347 MN Primary

Addresses

Primary practice location

3100 W Lake St Ste 210
Minneapolis, MN 55416-4597

Mailing address

3100 W Lake St Ste 210
Minneapolis, MN 55416-4597
Phone (612) 925-6033

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
I20180116000348 MN Practitioner - Clinical Social Worker 3678832847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Clinic of Psychology IncGroup PAC ID 0749171320, 136 clinicians

Practice addresses (Care Compare)

3100 W Lake St
Suite 210
Minneapolis, MN 55416-4597
Phone (612) 925-6033

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Clinic of Psychology Inc CurrentSince Dec 1, 2017 Accepting new patients

Locations

4240 Park Glen Rd
St Louis Park, MN 55416
Phone (612) 925-6033

4027 County Road 25
St Louis Park, MN 55416
Phone (612) 925-6033

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": "1512691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512691200000",
    "number": "1700391034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 W LAKE ST STE 210",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164597",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 W LAKE ST STE 210",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164597",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLING",
        "first_name": "REBEKAH",
        "middle_name": "J",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-08",
        "last_updated": "2017-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.