Individual provider Active NPI

James Fongers, MSW, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1235458878
Registry record updated May 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801017233 Issued in MI
Practice address
1870 Leonard St NE
Grand Rapids, MI 49505-5650
Phone
(616) 956-1122
NPI assigned
May 21, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2010

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 6801017233 MI Primary

Addresses

Primary practice location

1870 Leonard St NE
Grand Rapids, MI 49505-5650

Mailing address

1870 Leonard St NE
Grand Rapids, MI 49505-5650
Phone (616) 956-1122

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
I20140123000275 MI Practitioner - Clinical Social Worker 9436387305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2005
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)

1870 Leonard St NE
Christian Counseling Center Ministry of Pin
Grand Rapids, MI 49505-5650
Phone (616) 956-9619

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Mar 26, 2014 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Mar 26, 2014 Accepting new patients

Locations

1870 Leonard St NE
Grand Rapids, MI 49505
Phone (616) 956-1122

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

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": "1274400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274400000000",
    "number": "1235458878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 LEONARD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055650",
            "telephone_number": "616-956-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 LEONARD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055650",
            "telephone_number": "616-956-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONGERS",
        "first_name": "JAMES",
        "credential": "MSW, LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-21",
        "last_updated": "2010-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801017233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.