Individual provider Active NPI

Wayne Joseph Luebbert, MSW, LICSW

  • Clinical Social Worker
  • Rochester, MN
National Provider Identifier
1720308943
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
15967 Issued in MN
Practice address
1811 Greenview PL SW Ste 103
Rochester, MN 55902-4354
Phone
(507) 536-7662
Fax
(507) 536-7664
NPI assigned
Jun 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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 15967 MN Primary

Addresses

Primary practice location

1811 Greenview PL SW Ste 103
Rochester, MN 55902-4354

Mailing address

1900 Silver Lake Rd NW
New Brighton, MN 55112-1786
Phone (651) 628-9566

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
I20180618001403 MN Practitioner - Clinical Social Worker 3577818467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

1900 Silver Lake NWRD
Suite 110
New Brighton, MN 55112-1789

1900 Silver Lake Rd NW
New Brighton, MN 55112-1789
Phone (651) 628-9566

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15967MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD Clinical CurrentSince Jan 2, 2019 Accepting new patients

Locations

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

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": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1720308943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 GREENVIEW PL SW STE 103",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559024354",
            "telephone_number": "507-536-7662",
            "fax_number": "507-536-7664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUEBBERT",
        "first_name": "WAYNE",
        "middle_name": "JOSEPH",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-10",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.