Individual provider Active NPI

Charly Candas Vangrinsven, B.S.,LADC

  • Clinical Social Worker
  • Bemidji, MN
National Provider Identifier
1982077541
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27157 Issued in MN
Practice address
1705 Anne St NW
Bemidji, MN 56601-6151
Phone
(218) 333-5000
NPI assigned
Nov 4, 2015
Last updated
Oct 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 303368 MN
Addiction (Substance Use Disorder) Counselor 101YA0400X 1051960 MN
Clinical Social Worker 1041C0700X 27157 MN Primary

Addresses

Primary practice location

1705 Anne St NW
Bemidji, MN 56601-6151

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, MT3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20210601000712 MN Practitioner - Clinical Social Worker 2961801675 Reassigns benefits to 1 organization
I20240207000536 MN Practitioner - Mental Health Counselor 2961801675 Reassigns benefits to 1 organization
I20260408001716 MT Practitioner - Clinical Social Worker 2961801675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of North Dakota School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Health of Northern MinnesotaGroup PAC ID 5597725168, shared by 21 NPIs, 349 clinicians

Practice addresses (Care Compare)

Great Falls, MT 59404
Phone (218) 333-5000

1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000

1705 Anne St NW
Bemidji, MN 56601-6151
Phone (218) 333-5000

Merit-based Incentive Payment System (MIPS)

Final score
86.56 of 100Reported as group
Quality
74.25
Promoting interoperability
100
Improvement activities
40
Cost
76.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
1051960MNMDAddiction (Substance Use Disorder) Counselor
27157MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Mar 26, 2021 Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1705 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2035

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1982077541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016151",
            "telephone_number": "218-333-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANGRINSVEN",
        "first_name": "CHARLY",
        "middle_name": "CANDAS",
        "name_prefix": "Mrs.",
        "credential": "B.S.,LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "303368",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "1051960",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

Sources for this page

Verify at the official NPI Registry.