Individual provider Active NPI

Kurtis Steven Visker, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1184982787
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801091882 Issued in MI
Practice address
4127 Embassy Dr SE
Grand Rapids, MI 49546-2418
Phone
(616) 264-3205
Fax
(616) 264-3201
NPI assigned
May 2, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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 6801091882 MI Primary

Addresses

Primary practice location

4127 Embassy Dr SE
Grand Rapids, MI 49546-2418

Mailing address

1407 Alexander St SE
Grand Rapids, MI 49506-3301
Phone (616) 648-9532

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
I20130128000365 MI Practitioner - Clinical Social Worker 3072767060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4127 Embassy Dr SE
Grand Rapids, MI 49546-2418
Phone (616) 264-3202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801091882MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kurt Visker LLC Clinical CurrentSince Jan 27, 2020 Accepting new patients

Locations

4127 Embassy Dr SE
Grand Rapids, MI 49546
Phone (616) 264-3200

Organizations & group practices 1

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": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1184982787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 ALEXANDER ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063301",
            "telephone_number": "616-648-9532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4127 EMBASSY DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462418",
            "telephone_number": "616-264-3205",
            "fax_number": "616-264-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISKER",
        "first_name": "KURTIS",
        "middle_name": "STEVEN",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-02",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801091882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.