Organization Active NPI

Community Elevation LLC

Doing business as Community Elevation

  • Clinical Social Worker
  • Ann Arbor, MI
National Provider Identifier
1053034199
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
COMMUNITY ELEVATION LLC
Doing business as
Community Elevation
Practice address
3657 Burnham Rd
Ann Arbor, MI 48108-9662
Phone
(734) 263-9100
Fax
(734) 369-8544
NPI assigned
Sep 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Mr. Dellkawaa Paul Jacobs, LMSWNPI 1508317538
Title
Clinical Social Woker
Phone
(734) 263-9100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3657 Burnham Rd
Ann Arbor, MI 48108-9662

Mailing address

3657 Burnham Rd
Ann Arbor, MI 48108-9662
Phone (734) 263-9100

Other names 1

  • Community Elevation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250227003447 MI Part B Supplier - Clinic/Group Practice 9436679859 Receives reassigned benefits from 1 practitioner
Practice locations: Ann Arbor, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1053034199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3657 BURNHAM RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089662",
            "telephone_number": "734-263-9100",
            "fax_number": "734-369-8544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3657 BURNHAM RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089662",
            "telephone_number": "734-263-9100",
            "fax_number": "734-369-8544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ELEVATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-23",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DELLKAWAA",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WOKER",
        "authorized_official_telephone_number": "734-263-9100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Elevation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Elevation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.