Michael Jerome Bausano, SOCIAL WORKER
Individual provider Active NPI Clinical Social Worker · Canadian Lakes, MI
NPI 1255877965 · NPPES record last updated Apr 23, 2019
Key facts
- NPI
- 1255877965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801069870 (MI)
- Practice address
- 6713 Sunset LN
Canadian Lakes, MI 49346-8832 - Phone
- (231) 598-0894
- NPI assigned
- Jan 19, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250709002771 | MI | Practitioner - Clinical Social Worker | 7911411186 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resilience North LLC | Current |
Accepting new patients |
Locations
7050 9 Mile Rd
Mecosta, MI 49332
Phone (231) 679-6105
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801069870 | MI | Yes |
Addresses
Primary practice location
6713 Sunset LN
Canadian Lakes, MI 49346-8832
Mailing address
6713 Sunset LN
Canadian Lakes, MI 49346-8832
Phone (231) 598-0894
Other providers in Canadian Lakes, MI
- Beemer Enterprises Inc
- James D Biederbeck
- Canadian Lakes Eyecare, P.L.L.C.
- Neita I Dorais
- Erin Patrece Dressander
All providers in Canadian Lakes, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.