Active NPI
Jacob Pattenaude
- Clinical Social Worker
- Richmond, MI
National Provider Identifier
1013366194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 400 Stoddard Rd
Richmond, MI 48062-2505 - Phone
- (810) 392-2167
- NPI assigned
- Jun 8, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
400 Stoddard Rd
Richmond, MI 48062-2505
Mailing address
2570 Roselawn St
Wolverine Lake, MI 48390-1945
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1041C0700X | Medicaid | MI |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Wayne State University School of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
9409 N Haggerty Rd
Plymouth, MI 48170-4696
Phone (734) 559-3540
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transformational Services LLC | Clinical | Current | Accepting new patients |
Locations
9409 N Haggerty Rd
Plymouth, MI 48170
Phone (734) 231-3933
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.
-
- Clinical Social Worker
- Plymouth, MI
- NPI 1780090258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465344000000",
"number": "1013366194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2570 ROSELAWN ST",
"city": "WOLVERINE LAKE",
"state": "MI",
"postal_code": "483901945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 STODDARD RD",
"city": "RICHMOND",
"state": "MI",
"postal_code": "480622505",
"telephone_number": "810-392-2167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTENAUDE",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-08",
"last_updated": "2016-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1041C0700X",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.