Individual provider Active NPI

Katherine Suzanne Fitzkappes, LICSW

  • Clinical Social Worker
  • Montevideo, MN
National Provider Identifier
1831761675
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
15711 Issued in MN
Practice address
824 N 11TH St
Montevideo, MN 56265-1629
Phone
(320) 269-8877
Fax
(320) 321-8200
NPI assigned
Jul 12, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 7

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.

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Group practices
CCM Health 69 clinicians

Practice addresses (Care Compare)

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

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
I20210908001316 MN Practitioner - Clinical Social Worker 0941606586 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15711MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
CCM Health CurrentSince Aug 1, 2021 Accepting new patients
CCM Health CurrentSince Aug 1, 2021 Accepting new patients

Locations

824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 15711 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

824 N 11TH St
Montevideo, MN 56265-1629

Mailing address

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 12, 2021.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1831761675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-8877",
            "fax_number": "320-321-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-8877",
            "fax_number": "320-321-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZKAPPES",
        "first_name": "KATHERINE",
        "middle_name": "SUZANNE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montevideo, MN

Sources for this page

Verify at the official NPI Registry.