Active NPI
Stacia Martin
- Clinical Social Worker
- Brainerd, MN
National Provider Identifier
1760847370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 22557
- Practice address
- 823 Maple St
Brainerd, MN 56401-3770 - Phone
- (218) 330-8167
- NPI assigned
- Dec 24, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22557 | MN | Primary |
Addresses
Primary practice location
823 Maple St
Brainerd, MN 56401-3770
Mailing address
13915 Olivewood Dr
Baxter, MN 56425-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22557 | MN | MD | Geriatric Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Pines Mental Health Center, Inc. | Past | Accepting new patients | |
| Northern Pines Mental Health Center, Inc. | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Little Falls, MN
- NPI 1013904051
-
- Community/Behavioral Health Agency
- Brainerd, MN
- NPI 1225168602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450915200000",
"number": "1760847370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13915 OLIVEWOOD DR",
"city": "BAXTER",
"state": "MN",
"postal_code": "564254000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "823 MAPLE ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013770",
"telephone_number": "218-330-8167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "STACIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-24",
"last_updated": "2015-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "22557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.