Individual provider Active NPI

Mary L Rymanowski, LICSW

  • Clinical Social Worker
  • Moorhead, MN
National Provider Identifier
1871565929
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
14204 Issued in MN
Practice address
1301 8TH St S
Moorhead, MN 56560-3604
Phone
(701) 234-3100
Fax
(701) 234-3168
NPI assigned
Feb 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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 14204 MN Primary

Addresses

Primary practice location

1301 8TH St S
Moorhead, MN 56560-3604

Mailing address

8100 34TH Ave S
Mail Stop 21110Q
Bloomington, MN 55425-1672
Phone (952) 883-5463

Other identifiers 2

IdentifierTypeStateIssuer
155898600MedicaidMN
108H5RYOtherMNBLUE CROSS BLUE SHIELD

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
I20040513000370 MN Practitioner - Clinical Social Worker 0840280897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

Sauk Centre, MN 56378
Phone (701) 234-3200

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

4000 28TH Ave S
Moorhead, MN 56560-7926
Phone (701) 234-3200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14204MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Dec 16, 2019 Accepting new patients
Sanford Medical Center Fargo CurrentSince Dec 16, 2019 Accepting new patients

Locations

1301 8th St S
Moorhead, MN 56560
Phone (701) 234-3200

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1871565929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 34TH AVE S",
            "address_2": "MAIL STOP 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251672",
            "telephone_number": "952-883-5463",
            "fax_number": "952-883-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 8TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565603604",
            "telephone_number": "701-234-3100",
            "fax_number": "701-234-3168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYMANOWSKI",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "14204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155898600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "108H5RY",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.