Individual provider Active NPI

Debra Jesudowich, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1174211791
Registry record updated Dec 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801120917 Issued in MI
Practice address
1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Phone
(989) 331-1805
NPI assigned
May 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2025

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 6851116167 MI
Clinical Social Worker 1041C0700X 6801120917 MI Primary

Addresses

Primary practice location

1115 Ball Ave NE
Grand Rapids, MI 49505-5904

Mailing address

4558 Wilkshire Ave SW
Wyoming, MI 49548-4156

Other names 1

  • Debra Nelson Former name

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
I20251027001972 MI Practitioner - Clinical Social Worker 2961991419 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arbor Circle CorporationGroup PAC ID 2668362393, 18 clinicians

Practice addresses (Care Compare)

1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Phone (616) 459-7215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801120917MIMDClinical Social Worker
6851116167MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Arbor Circle Corporation Clinical CurrentSince Oct 6, 2025 Accepting new patients

Locations

1101 Ball Ave NE
Grand Rapids, MI 49505
Phone (616) 456-7775

1115 Ball Ave NE
Grand Rapids, MI 49505
Phone (616) 451-3001

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1174211791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4558 WILKSHIRE AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495484156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 BALL AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055904",
            "telephone_number": "989-331-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESUDOWICH",
        "first_name": "DEBRA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-01",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851116167",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801120917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "NELSON",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.