Individual provider Active NPI

Laura K Smith, LMSW CAADC

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1265725139
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801090489 Issued in MI
Practice address
201 Sheldon Blvd SE
Grand Rapids, MI 49503-4513
Phone
(616) 459-0255
NPI assigned
May 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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 6801090489 MI Primary

Addresses

Primary practice location

201 Sheldon Blvd SE
Grand Rapids, MI 49503-4513

Mailing address

100 Cherry St SE
Durham Clinic
Grand Rapids, MI 49503-4526
Phone (616) 965-8283

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pcerecords.network180.x@direct.mihin.net Direct

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
I20111207000878 MI Practitioner - Clinical Social Worker 3476728171 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kent County CMH AuthorityGroup PAC ID 9436314143, 63 clinicians

Practice addresses (Care Compare)

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 825-5412

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kent County CMH Authority CurrentSince Sep 1, 2016 Accepting new patients
Kent County CMH Authority CurrentSince Sep 1, 2016 Accepting new patients
Carla Miller Ma MSW Clinical PastSince Apr 1, 2020 Accepting new patients

Locations

790 Fuller Ave NE
Grand Rapids, MI 49503
Phone (616) 336-3765

Organizations & group practices 3

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": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1265725139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "address_2": "DURHAM CLINIC",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SHELDON BLVD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034513",
            "telephone_number": "616-459-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LAURA",
        "middle_name": "K",
        "credential": "LMSW CAADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-25",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801090489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcerecords.network180.x@direct.mihin.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "790 Fuller Ave NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495031918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.