Individual provider Active NPI

Michelle R Brown, LCSW

  • Social Worker
  • Janesville, WI
National Provider Identifier
1255082582
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
11430 Issued in WI
Practice address
17 S River St Ste 254
Janesville, WI 53548-3863
Phone
(608) 755-5260
NPI assigned
Jan 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 11430 WI Primary

Addresses

Primary practice location

17 S River St Ste 254
Janesville, WI 53548-3863

Mailing address

17 S River St Ste 254
Janesville, WI 53548-3863
Phone (608) 755-5260

Other names 1

  • Michelle R Scott Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20241210001258 WI Practitioner - Clinical Social Worker 0749715084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Trivium LLCGroup PAC ID 6800115676, 12 clinicians

Practice addresses (Care Compare)

17 S River St
Suite 254
Janesville, WI 53548-3863
Phone 60875552601215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11430WIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Trivium LLC CurrentSince Nov 27, 2024 Accepting new patients
Trivium LLC PastSince Jan 26, 2022 Accepting new patients

Locations

17 S River St
Ste 254
Janesville, WI 53548
Phone (608) 755-5260

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": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1255082582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST STE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483863",
            "telephone_number": "608-755-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST STE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483863",
            "telephone_number": "608-755-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "MICHELLE",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-18",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "11430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "SCOTT",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

Verify at the official NPI Registry.