KATIE MICHELLE NYSTROM (LICSW, MSW) – Social Worker, NPI 1699355339

KATIE MICHELLE NYSTROM (LICSW, MSW) is a healthcare provider. based in Crosby, Minnesota. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LICSW, MSW. They hold a License No. 21668 (MN). The NPI Number for KATIE MICHELLE NYSTROM (LICSW, MSW) is 1699355339

Main info

Female
10 Years Of Experience
Accepts Medicare Assignment
Name
KATIE MICHELLE NYSTROM (LICSW, MSW)
NPI
1699355339
Phone
(218) 546-7000
Address
320 EAST MAIN ST
Enumeration Date
8 April 2021
Last Update Date
29 November 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3209055971
Graduation Year
2016 (10 years ago)
PAC ID
8224438213
Group Practice PAC ID
4385009943
Professional Enrollment ID
I20210614000519
Address ID
MN562885000SP194XXWAYX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

2,310 CLINICAL SOCIAL WORKER in MN

Provider Addresses for KATIE MICHELLE NYSTROM (LICSW, MSW)

  • 320 EAST MAIN ST

    CROSBY, MN 56441

    Phone: (218) 546-7000

    Fax: (218) 546-4400

    Mailing address matches the actual address.

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: 2021-06-14

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
I20210614000519IClinical 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 56441)

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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: 4385009943View full group profile
NameSpecialtyState
Nurse PractitionerMN
Nurse PractitionerND
Nurse PractitionerMN

Reviews

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Frequently asked questions

Can I use this page to confirm KATIE MICHELLE NYSTROM (LICSW, MSW)'s NPI?
Yes. KATIE MICHELLE NYSTROM (LICSW, MSW) is listed with NPI 1699355339 in the public NPI dataset.
Does CMS list KATIE MICHELLE NYSTROM (LICSW, MSW) as active?
Yes — KATIE MICHELLE NYSTROM (LICSW, MSW) is active in the NPI listing used on this page.
What healthcare role does KATIE MICHELLE NYSTROM (LICSW, MSW) hold?
Scheduling teams often label KATIE MICHELLE NYSTROM (LICSW, MSW) under Social Worker. Clinical services aligned with this taxonomy classification.
What address line appears for KATIE MICHELLE NYSTROM (LICSW, MSW)?
KATIE MICHELLE NYSTROM (LICSW, MSW)'s geographic hint is Crosby, Minnesota in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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