Individual provider Active NPI

Linda Ann Johnson, LCSW, LMSW

  • Clinical Social Worker
  • Spring Lake, MI
National Provider Identifier
1093853863
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801066138 Issued in MI
Practice address
17325 Van Wagoner Rd
Spring Lake, MI 49456-9702
Phone
(616) 847-5145
NPI assigned
Feb 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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 LC12201 ME
Clinical Social Worker 1041C0700X 6801066138 MI Primary

Addresses

Primary practice location

17325 Van Wagoner Rd
Spring Lake, MI 49456-9702

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other identifiers 2

IdentifierTypeStateIssuer
435265199MedicaidME
LJ066138OtherBCBS

Other names 1

  • Linda Ann Risselade Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100315000405 ME Practitioner - Clinical Social Worker 8123153202 Reassigns benefits to 1 organization
I20231024000242 MI Practitioner - Clinical Social Worker 8123153202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17325 Van Wagoner Rd
Spring Lake, MI 49456-9702
Phone (616) 847-5145

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC12201MEMDClinical Social Worker
6801066138MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Sep 20, 2023 Accepting new patients
Spurwink Services Incorporated CurrentSince Apr 22, 2017 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Sep 20, 2023 Accepting new patients

Locations

901 Washington Ave
Ste 100
Portland, ME 04103
Phone 20787112112145

9 Hillcrest Ave
Randolph, ME 04346
Phone (207) 582-9205

17325 Van Wagoner Rd
Spring Lake, MI 49456
Phone (616) 846-9100

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1093853863",
    "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": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17325 VAN WAGONER RD",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-847-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LINDA",
        "middle_name": "ANN",
        "credential": "LCSW, LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC12201",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801066138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435265199",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "LJ066138",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDA",
            "last_name": "RISSELADE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Spring Lake, MI

Sources for this page

Verify at the official NPI Registry.