Active NPI
Caleb Gibson
- Community Health Worker
- Shelby TWP, MI
National Provider Identifier
1265836555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- G125108734572
- Practice address
- 48343 Jerome Dr
Shelby TWP, MI 48315-4045 - Phone
- (586) 382-5514
- Fax
- (586) 739-9037
- NPI assigned
- Oct 15, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | G125108734572 | MI | Primary |
Addresses
Primary practice location
48343 Jerome Dr
Shelby TWP, MI 48315-4045
Mailing address
48343 Jerome Dr
Shelby TWP, MI 48315-4045
Phone (586) 382-5514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G125108734572 | MI | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413331200000",
"number": "1265836555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48343 JEROME DR",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483154045",
"telephone_number": "586-382-5514",
"fax_number": "586-739-9037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48343 JEROME DR",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483154045",
"telephone_number": "586-382-5514",
"fax_number": "586-739-9037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "CALEB",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-15",
"last_updated": "2014-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "MI",
"license": "G125108734572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelby TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.