Individual provider Active NPI

Andrea Kristin Smothers, MSW LICSW

  • Clinical Social Worker
  • Zumbrota, MN
National Provider Identifier
1700813623
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10122 Issued in MN
Practice address
77 West 5TH Street
Zumbrota, MN 55992
Phone
(507) 732-4136
Fax
(507) 732-4411
NPI assigned
Jun 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 10122 MN Primary

Addresses

Primary practice location

77 West 5TH Street
Zumbrota, MN 55992

Mailing address

PO Box 134
Zumbrota, MN 55992
Phone (507) 732-4136

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
I20040826000316 MN Practitioner - Clinical Social Worker 0840265633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

77 W 5TH St
Zumbrota, MN 55992-1648
Phone (507) 732-4136

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Covered Bridge Family Resources LLC Clinical CurrentSince Dec 1, 2003 Accepting new patients

Locations

77 W 5th St
Zumbrota, MN 55992
Phone (507) 201-2258

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700813623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 134",
            "city": "ZUMBROTA",
            "state": "MN",
            "postal_code": "55992",
            "telephone_number": "507-732-4136",
            "fax_number": "507-732-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 WEST 5TH STREET",
            "city": "ZUMBROTA",
            "state": "MN",
            "postal_code": "55992",
            "telephone_number": "507-732-4136",
            "fax_number": "507-732-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMOTHERS",
        "first_name": "ANDREA",
        "middle_name": "KRISTIN",
        "name_prefix": "Mrs.",
        "credential": "MSW LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "10122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zumbrota, MN

Sources for this page

Verify at the official NPI Registry.