Individual provider Active NPI

Ricardo Polendo, LICSW

  • Clinical Social Worker
  • Saint Paul, MN
National Provider Identifier
1730567926
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
19800 Issued in MN
Practice address
402 University Ave E
Saint Paul, MN 55130-4400
Phone
(651) 266-7900
Fax
(651) 266-7854
NPI assigned
May 8, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2015

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 19800 MN Primary

Addresses

Primary practice location

402 University Ave E
Saint Paul, MN 55130-4400

Mailing address

967 Lydia Dr W
Roseville, MN 55113-1924
Phone (651) 428-0875

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
I20191030001488 MN Practitioner - Clinical Social Worker 5496087108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1919 University Ave W
Suite 200
Saint Paul, MN 55104-3435
Phone (651) 523-7999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19800MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ramsey County Mental Health Center CurrentSince Oct 1, 2019 Accepting new patients
Ramsey County Mental Health Center CurrentSince Oct 1, 2019 Accepting new patients

Locations

1919 University Ave W
Ste 20
Saint Paul, MN 55104

1919 University Ave W
Ste 200
Saint Paul, MN 55104
Phone (651) 266-7999

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: ricardo.polendo.p3@direct.ramseysocialservices.nextgenshare.com

Organizations & group practices 2

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": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1730567926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 LYDIA DR W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131924",
            "telephone_number": "651-428-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551304400",
            "telephone_number": "651-266-7900",
            "fax_number": "651-266-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLENDO",
        "first_name": "RICARDO",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-08",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.