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ADDY NELSON LSW
NPI 1063937472
Counselor - Addiction (Substance Use Disorder) in Fargo, ND

Active since August 07, 2017PECOS EnrolledAccepts Medicare Assignment
2624 9TH AVE S, FARGO, ND 58103(701) 298-4500(701) 298-4400 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 21, 2022, Jan 28, 2021, Sep 9, 2020 and 1 more (4 updates tracked since 2017).

About Addy Nelson Lsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ADDY NELSON LSW (NPI 1063937472) is an individual addiction (substance use disorder) provider in Fargo, North Dakota, licensed in North Dakota (1821) and active in the NPI registry since August 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1063937472
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameADDY NELSONCredential: LSW
Location Address2624 9TH AVE SFargo, ND 58103-2350
Mailing Address2624 9th Ave SFargo, ND 58103-2350 · (701) 298-4500 · Fax (701) 298-4400
Phone(701) 298-4500
Fax(701) 298-4400
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateAugust 7, 2017
Last NPPES UpdateJuly 21, 20224 updates tracked since enumeration
NPPES CertifiedJanuary 28, 2021
✔ NPI 1063937472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in ND · 1821
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 1038-11-1-19A (ND)
Also ListedSocial WorkerTaxonomy 104100000X · License 4835 (ND)
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
2624 9TH AVE S, Fargo, ND 58103
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of North Dakota, Sanford Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Addy Nelson Lsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3870939622
PECOS Enrollment IDI20240314003127
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Addy Nelson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southeast Behavioral Health Clinic
Same address
Rehabilitation, Substance Use Disorder
2624 9TH AVE S
Fargo, ND 58103
  • Reassigned Medicare billing, North Dakota enrollment
  • Medicare enrollment name: Southeast Human Service Center
  • 91 clinicians in this Medicare group
NPI 1932146941 (701) 298-4500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNY WEST
Specialist
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4500
SHAYLA ZASTE TCM
Case Manager/Care Coordinator
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 595-4861
DETON HART
Counselor (Professional)
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4500
VALENTINA B ASIEDU MPH, CHES
Case Manager/Care Coordinator
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4959
MS. SARA L NICOLI M.ED, LAC
Counselor (Addiction (Substance Use Disorder))
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4500
DALE A CARRIER LPCC
Counselor
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4500
JENNIFER LEONE MULLEN LSW
Social Worker
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4500
TRACY DIEDRICH
Case Manager/Care Coordinator
2624 9TH AVE S
FARGO, ND 58103
Cass County (701) 298-4500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Addy Nelson's NPI number?

The NPI number for Addy Nelson is 1063937472. It was assigned to this individual provider in the NPPES registry on August 7, 2017.

Where is Addy Nelson located?

Addy Nelson practices at 2624 9th Ave S, Fargo, ND 58103. The listed phone number is (701) 298-4500.

What is Addy Nelson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Addy Nelson enrolled in Medicare?

Yes. Addy Nelson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Addy Nelson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Addy Nelson reassigns Medicare benefits to Southeast Behavioral Health Clinic (Fargo, ND). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Addy Nelson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Addy Nelson accept?

Health plans from Blue Cross Blue Shield of North Dakota and Sanford Health Plan list Addy Nelson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Addy Nelson was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.