Individual provider Active NPI

Abby Phillips, LMSW

  • Clinical Social Worker
  • Caledonia, MI
National Provider Identifier
1063094936
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801093456 Issued in MI
Practice address
6505 Cherry Meadow Dr SE
Caledonia, MI 49316-9484
Phone
(616) 281-6363
NPI assigned
Apr 21, 2021
Last updated
Apr 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801093456 MI Primary

Addresses

Primary practice location

6505 Cherry Meadow Dr SE
Caledonia, MI 49316-9484

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 281-6363

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
I20210526000124 MI Practitioner - Clinical Social Worker 5294134177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6505 Cherry Meadow Dr SE
Pine Rest Caledonia Clinic
Caledonia, MI 49316-9484
Phone (616) 891-8770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Apr 21, 2021 Accepting new patients
Pine Rest Christian Mental Health Services Social Worker CurrentSince Apr 21, 2021 Accepting new patients

Locations

6505 Cherry Meadow Dr SE
Caledonia, MI 49316
Phone (616) 281-6363

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1063094936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-281-6363",
            "fax_number": "616-455-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6505 CHERRY MEADOW DR SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169484",
            "telephone_number": "616-281-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "ABBY",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801093456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caledonia, MI

Sources for this page

Verify at the official NPI Registry.