Individual provider Active NPI

Jennifer Lynn Potter, LMSW

  • Clinical Social Worker
  • Muskegon, MI
National Provider Identifier
1063904811
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801120888 Issued in MI
Practice address
1550 Clinton St
Muskegon, MI 49442-5023
Phone
(231) 737-1335
Fax
(231) 737-0534
NPI assigned
Jun 6, 2018
Last updated
Sep 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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 6801120888 MI Primary

Addresses

Primary practice location

1550 Clinton St
Muskegon, MI 49442-5023

Mailing address

2700 Baker St
Muskegon, MI 49444-2157
Phone (231) 737-1335

Other practice location 1

300 68th St SE
Grand Rapids, MI 49548-6927
Phone (616) 281-6372

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
I20251014002942 MI Practitioner - Clinical Social Worker 5698262640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kristine Koetje Ma, PCGroup PAC ID 3375701873, 21 clinicians

Practice addresses (Care Compare)

17224 Van Wagoner Rd
Spring Lake, MI 49456-9702
Phone (616) 296-2130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801120888MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hackley Community Care Center Inc CurrentSince Sep 19, 2025 Accepting new patients
Hackley Community Care Center, Inc CurrentSince Sep 19, 2025 Accepting new patients
Kristine Koetje Ma, PC CurrentSince Sep 19, 2025 Accepting new patients

Locations

376 E Apple Ave
Muskegon, MI 49442
Phone (231) 724-3699

1550 Clinton St
Muskegon, MI 49442
Phone (231) 733-6910

1675 Leahy St
Ste 103
Muskegon, MI 49442
Phone (231) 728-4915

2700 Baker St
Fl 3
Muskegon Heights, MI 49444
Phone (231) 733-6607

2700 Baker St
Muskegon Hts, MI 49444
Phone (231) 737-8603

17224 Van Wagoner Rd
Spring Lake, MI 49456
Phone (616) 296-2130

Organizations & group practices 3

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": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1063904811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 BAKER ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442157",
            "telephone_number": "231-737-1335",
            "fax_number": "231-737-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 CLINTON ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425023",
            "telephone_number": "231-737-1335",
            "fax_number": "231-737-0534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 68th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495486927",
            "country_code": "US",
            "telephone_number": "616-281-6372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTER",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-06",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801120888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.