Individual provider Active NPI

Alison Lee Rudick, LMSW

  • Clinical Social Worker
  • Muskegon, MI
National Provider Identifier
1194323436
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801108184 Issued in MI
Practice address
1556 Loumilen Dr
Muskegon, MI 49445-1584
Phone
(616) 889-6607
NPI assigned
Oct 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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 6801108184 MI Primary

Addresses

Primary practice location

1556 Loumilen Dr
Muskegon, MI 49445-1584

Mailing address

3084 Klug St
Muskegon, MI 49444-3223
Phone (616) 889-6607

Other identifiers 1

IdentifierTypeStateIssuer
6801118519OtherMILICENSE

Other names 1

  • Alison L Wyatt Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL laptop

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
I20240807002092 MI Practitioner - Clinical Social Worker 4789121880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kristine Koetje Ma, PCGroup PAC ID 3375701873, 21 clinicians

Practice addresses (Care Compare)

17224 Van Wagoner Rd
Spring Lake, MI 49456-9702
Phone (616) 296-2130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801108184MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kristine Koetje Ma, PC CurrentSince May 23, 2024 Accepting new patients

Locations

17224 Van Wagoner Rd
Spring Lake, MI 49456
Phone (616) 296-2130

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": "1602201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1194323436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3084 KLUG ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494443223",
            "telephone_number": "616-889-6607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1556 LOUMILEN DR",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494451584",
            "telephone_number": "616-889-6607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDICK",
        "first_name": "ALISON",
        "middle_name": "LEE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-09",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801108184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6801118519",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "address_1": "3084 Klug St",
            "city": "Muskegon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494443223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALISON",
            "last_name": "WYATT",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.