Jeanne L Stark, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801088180 Issued in MI

Practice address

3351 Claystone St SE
Ste. 212
Grand Rapids, MI 49546-5781

Phone

(616) 954-1992

Fax

(616) 954-1998

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pine Rest Christian Mental Health Services

  • Social Worker
  • Grand Rapids, MI
  • NPI 1922019157
  Medicare reassignment Care Compare group NPD
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD
• Life Guidance Services

  • Social Worker
  • Grand Rapids, MI
  • NPI 1336185032
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1194886846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 PARKWAY PL SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182695",
            "telephone_number": "616-530-9011",
            "fax_number": "616-530-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 CLAYSTONE ST SE",
            "address_2": "STE. 212",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465781",
            "telephone_number": "616-954-1992",
            "fax_number": "616-954-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "JEANNE",
        "middle_name": "L",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801088180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Staple, RN
• Cherina Dawn Johnson Staples, LPC
• Andrea Stark, MA, CCC-SLP
• Emily Marie Stark, LMSW
• Erin Anne Stark, RD
• Matthew Charles Starke, M.D.
• Elaine Rocio Starkey
• Starling Therapy
• Rubee Ann Starling, BEHAVIOR TECHNICIAN
• Steven Michael Starling

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.