LUANN ANNETTE GAMMON (LICSW) – Clinical Social Worker, NPI 1053630053

LUANN ANNETTE GAMMON (LICSW) is a healthcare provider. based in Staples, Minnesota. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LICSW. They hold a License No. 9493 (MN). The NPI Number for LUANN ANNETTE GAMMON (LICSW) is 1053630053

Main info

Female
Sole Proprietor
19 Years Of Experience
Accepts Medicare Assignment
Name
LUANN ANNETTE GAMMON (LICSW)
NPI
1053630053
Phone
(218) 894-1515
Address
49725 COUNTY 83
Enumeration Date
31 May 2010
Last Update Date
15 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2188941515
Graduation Year
2007 (19 years ago)
PAC ID
7517119324
Group Practice PAC ID
1052229671
Professional Enrollment ID
I20121130000139
Address ID
MN564795280ST49725COUN203
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience56
Completeness75
Years active:16State licenses:1Digital endpointsOther names

2,310 CLINICAL SOCIAL WORKER in MN

Provider Addresses for LUANN ANNETTE GAMMON (LICSW)

  • 49725 COUNTY 83

    STAPLES, MN 564795280

    Phone: (218) 894-1515

    Fax: (218) 894-8767

    Type: Location

  • 11414 GREAT RIVER RD

    LITTLE FALLS, MN 563454537

    Phone: (320) 632-2400

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2012-11-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20121130000139IClinical Social WorkerMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 56479)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052229671View full group profile
NameSpecialtyState
Nurse PractitionerMN
Clinical Social WorkerMN
Family PracticeMN
Nurse PractitionerMN
-MN
Certified Registered Nurse Anesthetist (Crna)MN
Internal Medicine, Pulmonary Disease, Pulmonary Disease, Internal Medicine, Critical Care (Intensivists), Critical Care (Intensivists)IA
O B S T E T R I C S/ G Y N E C O L O G YMN
Emergency Medicine, Family PracticeMN
Diagnostic RadiologyMN

Reviews

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Frequently asked questions

Can I verify LUANN ANNETTE GAMMON (LICSW) with an NPI only?
You can start verification with NPI 1053630053 for LUANN ANNETTE GAMMON (LICSW), then check state licensing separately.
Does CMS list LUANN ANNETTE GAMMON (LICSW) as active?
Yes — LUANN ANNETTE GAMMON (LICSW) is active in the NPI listing used on this page.
What is LUANN ANNETTE GAMMON (LICSW)'s primary classification?
Clinical Social Worker is the headline specialty for LUANN ANNETTE GAMMON (LICSW) here. Clinical services aligned with this taxonomy classification.
Does LUANN ANNETTE GAMMON (LICSW) list a practice location?
Patients near Staples, Minnesota may find LUANN ANNETTE GAMMON (LICSW) in results; validate coverage separately.
How many locations tie to this NPI?
4 practice locations appear in the available data.

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