Individual provider Active NPI

Carrie Pernesky, LMSW

  • Social Worker
  • Holland, MI
National Provider Identifier
1164855946
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801106124 Issued in MI
Practice address
12265 James St
Holland, MI 49424-8613
Phone
(616) 393-5600
NPI assigned
Aug 15, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801106124 MI Primary

Addresses

Primary practice location

12265 James St
Holland, MI 49424-8613

Mailing address

12265 James St
Holland, MI 49424-8613
Phone (616) 393-5600

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
I20250428002293 MI Practitioner - Clinical Social Worker 4183140635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of South Carolina School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of OttawaGroup PAC ID 0042118036, 18 clinicians

Practice addresses (Care Compare)

12265 James St
Holland, MI 49424-8613
Phone (616) 393-5641

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801106124MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Ottawa CurrentSince Feb 15, 2025 Accepting new patients
County of Ottawa CurrentSince Feb 15, 2025 Accepting new patients
Ottawa County CMH Past Accepting new patients

Locations

1111 Fulton Ave
Grand Haven, MI 49417
Phone (616) 842-5350

12265 James St
Holland, MI 49424
Phone (616) 392-1873

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": "1376524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1164855946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12265 JAMES ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248613",
            "telephone_number": "616-393-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12265 JAMES ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248613",
            "telephone_number": "616-393-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERNESKY",
        "first_name": "CARRIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801106124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.