Individual provider Active NPI

Doris Monica Geldres, MSW

  • Social Worker
  • Ypsilanti, MI
National Provider Identifier
1063773091
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801074099 Issued in MI
Practice address
5508 Michael Dr
Ypsilanti, MI 48197-6781
Phone
(734) 546-3366
NPI assigned
Jun 6, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801074099 MI
Social Worker 104100000X 6801074099 MI Primary

Addresses

Primary practice location

5508 Michael Dr
Ypsilanti, MI 48197-6781

Mailing address

5508 Michael Dr
Ypsilanti, MI 48197-6781
Phone (734) 546-3366

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
I20181206003079 MI Practitioner - Clinical Social Worker 2466796164 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Counseling Solutions IncGroup PAC ID 4082648365, 15 clinicians

Practice addresses (Care Compare)

1700 Waterman St
Detroit, MI 48209-2022
Phone (313) 841-8900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Counseling Solutions Clinical CurrentSince Dec 22, 2022 Accepting new patients

Locations

5716 Michigan Ave
Detroit, MI 48210
Phone (313) 554-1095

1700 Waterman St
Detroit, MI 48209
Phone (313) 841-8900

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": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1063773091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5508 MICHAEL DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481976781",
            "telephone_number": "734-546-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5508 MICHAEL DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481976781",
            "telephone_number": "734-546-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GELDRES",
        "first_name": "DORIS",
        "middle_name": "MONICA",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-06",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801074099",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801074099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.