SOUKTHANOME THAMMAVONG (LICSW) – Clinical Social Worker, NPI 1164986246
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,310 CLINICAL SOCIAL WORKER in MN
Provider Addresses for SOUKTHANOME THAMMAVONG (LICSW)
2001 Bloomington Ave
Minneapolis, MN 554043074
Phone: (612) 249-0941
Fax: (612) 301-1040
Type: Location
Richfield Parkway, Diamond Lake, Minneapolis, Hennepin County, Minnesota, 55450, United States
MINNEAPOLIS, MN 554043074
Phone: (612) 249-0941
Type: Mailing
Central Avenue Northeast, Columbia Heights, Anoka County, Minnesota, 55421, United States
COLUMBIA HEIGHTS, MN 554212960
Phone: (763) 283-7194
Fax: (612) 437-4535
Type: Location
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: 2019-03-21
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190321000408 | I | Clinical Social Worker | MN | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | 11 | 11 | $0 |
Insurance plans in this area (ZIP 55404)
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