LISA M BRENNOM LICSW
NPI 1437179611
Social Worker - Clinical in Minnetonka, MN
About Lisa M Brennom Licsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LISA M BRENNOM LICSW (NPI 1437179611) is an individual clinical provider in Minnetonka, Minnesota, licensed in Mississippi (13588) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS, maintains a secondary practice location in Minneapolis, and is a graduate of University Of Minnesota Medical School (1997).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lisa M Brennom Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Lisa Brennom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Edina, MN 55439
- Reassigned Medicare billing, Minnesota enrollment
- Medicare enrollment name: Affinity Psychological Services PC
- 136 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55305 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
MINNETONKA, MN 55305
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 Lisa Brennom's NPI number?
The NPI number for Lisa Brennom is 1437179611. It was assigned to this individual provider in the NPPES registry on July 20, 2006.
Where is Lisa Brennom located?
Lisa Brennom practices at 3395 Plymouth Rd, Minnetonka, MN 55305. The listed phone number is (952) 939-0396.
What is Lisa Brennom's specialty?
The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.
Is Lisa Brennom enrolled in Medicare?
Yes. Lisa Brennom is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Lisa Brennom's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Lisa Brennom reassigns Medicare benefits to Affinity Psychological Services, P.C. (Edina, MN). 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 Lisa Brennom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Lisa Brennom accept?
Health plans from Medica list Lisa Brennom 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 Lisa Brennom was last updated on May 3, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Lisa M Brennom, LICSW · NPI 1437179611
Clinical provider in Minnetonka, Minnesota. Individual provider, active in the CMS NPPES registry since July 20, 2006.
## Identity
- **NPI:** 1437179611 (Entity type: Individual)
- **Enumerated:** July 20, 2006
- **Primary specialty:** Social Worker - Clinical · taxonomy 1041C0700X
- **State license:** 13588 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 3395 PLYMOUTH RD, Minnetonka, MN 55305-3765
- **Phone:** (952) 939-0396
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Affinity Psychological Services, P.C. (NPI 1245610856, Edina, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Minnesota Medical School, class of 1997
## Record status
- **NPPES last updated:** May 3, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1437179611) · Data from the CMS NPPES public registry.