Individual provider Active NPI

Garrett Shotwell, LMSW

  • Social Worker
  • Ann Arbor, MI
National Provider Identifier
1275074262
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801116110 Issued in MI
Practice address
342 S Ashley St
Ann Arbor, MI 48104-1351
Phone
(773) 318-7304
NPI assigned
Mar 10, 2017
Last updated
Jan 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801116110 MI Primary
Clinical Social Worker 1041C0700X SC 60708502 WA
Clinical Social Worker 1041C0700X 149020299 IL

Addresses

Primary practice location

342 S Ashley St
Ann Arbor, MI 48104-1351

Mailing address

1715 Abbott Ave
Ann Arbor, MI 48103-4107
Phone (773) 318-7304

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
I20241231001562 MI Practitioner - Clinical Social Worker 8224465810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Lafayette Chiropractic Institute, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC 60708502WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation CurrentSince Dec 1, 2024 Accepting new patients
Illumination Psychotherapy, PLLC CurrentSince Apr 14, 2024 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Service Corporation CurrentSince Dec 1, 2024 Accepting new patients
Sandbox Therapy Group, Inc. Clinical PastSince Aug 28, 2022 Accepting new patients

Locations

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1275074262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 ABBOTT AVE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481034107",
            "telephone_number": "773-318-7304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 S ASHLEY ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481041351",
            "telephone_number": "773-318-7304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOTWELL",
        "first_name": "GARRETT",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-10",
        "last_updated": "2025-01-07",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801116110",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC 60708502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149020299",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.