Individual provider Active NPI

Poonam Shyam Melwani

  • Social Worker
  • Southgate, MI
National Provider Identifier
1003386335
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801104153 Issued in MI
Practice address
13101 Allen Rd
Southgate, MI 48195-2216
Phone
(734) 785-7705
NPI assigned
Nov 29, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801099909 MI
Social Worker 104100000X 6801104153 MI Primary

Addresses

Primary practice location

13101 Allen Rd
Southgate, MI 48195-2216

Mailing address

13101 Allen Rd
Southgate, MI 48195-2216

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190813002314 MI Practitioner - Clinical Social Worker 0941537963 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801099909MIMDSocial Worker
6801104153MIMDSocial Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1003386335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13101 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13101 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952216",
            "telephone_number": "734-785-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELWANI",
        "first_name": "POONAM",
        "middle_name": "SHYAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-29",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801099909",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801104153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

Verify at the official NPI Registry.