Active NPI
Keith Clepper, LICSW, LADC
- Clinical Social Worker
- Fridley, MN
National Provider Identifier
1982054987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 21855
- Practice address
- 550 Osborne Rd NE
Fridley, MN 55432 - Phone
- (763) 236-4635
- Fax
- (763) 236-4370
- NPI assigned
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 302390 | MN | |
| Clinical Social Worker | 1041C0700X | 21855 | MN | Primary |
Addresses
Primary practice location
550 Osborne Rd NE
Fridley, MN 55432
Mailing address
550 Osborne Rd. NE
Mr 53450
Fridley, MN 55432
Phone (763) 236-4635
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160722000288 | MN | Practitioner - Clinical Social Worker | 0749573129 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Allina Health System
Practice addresses (Care Compare)
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (866) 603-0016
Hospital & facility affiliations
- Mercy Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.6 of 100
- Quality
- 72.5
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.07
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302390 | MN | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
480 Osborne Rd NE
Ste 260
Minneapolis, MN 55432
Phone (763) 236-3800
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
Interoperability endpoints
- kclepper60268@excellian.direct.allina.com
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Cottage Grove, MN
- NPI 1568768919
-
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Addiction (Substance Use Disorder) Psychologist
- Fridley, MN
- NPI 1083197214
Hospital
-
- Substance Use Disorder Rehabilitation Hospital Unit
- Fridley, MN
- NPI 1285692145
Hospital
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fridley, MN
- NPI 1598700528
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1982054987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 OSBORNE RD. NE",
"address_2": "MR 53450",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "55432",
"telephone_number": "763-236-4635",
"fax_number": "763-236-4370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 OSBORNE RD NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "55432",
"telephone_number": "763-236-4635",
"fax_number": "763-236-4370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEPPER",
"first_name": "KEITH",
"credential": "LICSW, LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-21",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "302390",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "21855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.