Individual provider Active NPI

Michelle Renee Palu

  • Clinical Social Worker
  • Colorado Springs, CO
National Provider Identifier
1285881334
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
09924592 Issued in CO
Practice address
875 W Moreno Ave
Colorado Springs, CO 80905-1731
Phone
(719) 572-6290
NPI assigned
Aug 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 09924592 CO Primary

Addresses

Primary practice location

875 W Moreno Ave
Colorado Springs, CO 80905-1731

Mailing address

875 W Moreno Ave
Colorado Springs, CO 80905-1731
Phone (719) 572-6290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20170505000067 CO Practitioner - Clinical Social Worker 6901183656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Diversus Health IncGroup PAC ID 7719879204, 49 clinicians

Practice addresses (Care Compare)

115 S Parkside Dr
Colorado Springs, CO 80910-3130
Phone (719) 572-6100

179 S Parkside Dr
Colorado Springs, CO 80910-3130
Phone (719) 572-6100

220 Ruskin Dr
Colorado Springs, CO 80910-2522
Phone (719) 572-6100

6208 Lehman Dr
Colorado Springs, CO 80918-8408
Phone (719) 572-6100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
09924592COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Diversus Health Inc CurrentSince Apr 1, 2017 Accepting new patients
Diversus Health Inc CurrentSince Apr 1, 2017 Accepting new patients
Diversus Health Inc Current Accepting new patients

Locations

460 County Road 43
Ste 7
Bailey, CO 80421
Phone (303) 838-5013

328 10th St
Calhan, CO 80808

179 S Parkside Dr
Colorado Springs, CO 80910
Phone (719) 572-6300

1795 Jet Wing Dr
Colorado Springs, CO 80916
Phone (719) 572-6111

6208 Lehman Dr
Colorado Springs, CO 80918
Phone (719) 572-6133

875 W Moreno Ave
Colorado Springs, CO 80905
Phone (719) 572-6200

220 Ruskin Dr
Colorado Springs, CO 80910
Phone (719) 572-6150

413 Security Blvd
Colorado Springs, CO 80911

115 S Parkside Dr
Colorado Springs, CO 80910
Phone (719) 572-6340

18401 Highway 24
Ste 119
Woodland Park, CO 80863

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": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1285881334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 W MORENO AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809051731",
            "telephone_number": "719-572-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 W MORENO AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809051731",
            "telephone_number": "719-572-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALU",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "09924592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.