Kristin Petersen

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21218 Issued in MN

Practice address

26246 Crane Rd
White Earth, MN 56591-9998

Phone

(218) 983-4703

NPI assigned

Dec 30, 2016

Last updated

Dec 30, 2016By the provider in NPPES

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

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, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MN

  Medicare reassignment NPD

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

{
    "created_epoch": "1483056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483056000000",
    "number": "1710422779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6578 BIG BASS RD NE",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566018674",
            "telephone_number": "218-760-6543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565919998",
            "telephone_number": "218-983-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KRISTIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-30",
        "last_updated": "2016-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Jacobson, LPCC
• Sarah Jane Jasken, M.S.W; LICSW
• Diane McArthur, RD,LD
• Justin Douglas McDonald, PH.D.
• Amy Nathe, LPCC
• Shania Rentschler, LPCC
• Nancy Fredericka Samura
• James M. Schmitt, LSW
• Vanessa Rae Simon, MS, NCC, LPCC
• Judy Simpson, LICSW

• Clinical Social Worker in White Earth, MN
• Providers in White Earth, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; 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.