Active NPI
Michael Stuart Immerman, MSW
- Clinical Social Worker
- San Mateo, CA
National Provider Identifier
1174703367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS14796
- Practice address
- 177 Bovet Rd
Suite 540
San Mateo, CA 94402-3116 - Phone
- (650) 573-5780
- Fax
- (650) 341-9680
- NPI assigned
- Nov 6, 2007
- Last updated
- Nov 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS14796 | CA | Primary |
Addresses
Primary practice location
177 Bovet Rd
Suite 540
San Mateo, CA 94402-3116
Mailing address
177 Bovet Rd
Suite 540
San Mateo, CA 94402-3116
Phone (650) 573-5780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS14796 | CA | MD | Clinical Social Worker |
| 14796 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194307200000",
"number": "1174703367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 BOVET RD",
"address_2": "SUITE 540",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944023116",
"telephone_number": "650-573-5780",
"fax_number": "650-341-9680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 BOVET RD",
"address_2": "SUITE 540",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944023116",
"telephone_number": "650-573-5780",
"fax_number": "650-341-9680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMMERMAN",
"first_name": "MICHAEL",
"middle_name": "STUART",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-06",
"last_updated": "2007-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS14796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
- Shannon Keiko Ikeda
- Kathleen Ikuta, PT
- Jun Mee Im
- Shirin Shahinfar Imani, DDS
- Immediate Medical Care Inc
- Impakt Medical, LLC (Impakt Medical)
- Inadvance Medicine Associates West, P. C. (Passport Health)
- Insightful Growth Therapy Inc
- Internal Medicine Associates of San Mateo
- Intero Chiropractic a Hsieh Corporation D
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.