Active NPI
Philip Dezern
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1295509859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851093862
- Practice address
- 5020 E Beltline Ave NE
Grand Rapids, MI 49525-6869 - Phone
- (616) 439-1866
- NPI assigned
- Nov 14, 2023
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6851093862 | MI | Primary |
Addresses
Primary practice location
5020 E Beltline Ave NE
Grand Rapids, MI 49525-6869
Mailing address
5050 Rum Creek CT SE
Kentwood, MI 49508-5280
Phone (616) 633-0994
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3351 Eagle Run Dr NE
Suite a
Grand Rapids, MI 49525-7070
5050 Rum Creek CT SE
Kentwood, MI 49508-5280
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851093862 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unity Counseling LLC | Current | Accepting new patients |
Locations
5020 E Beltline Ave NE
Ste 202
Grand Rapids, MI 49525
Phone (616) 405-0637
Organizations & group practices 1
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.
-
- Professional Counselor
- Grand Rapids, MI
- NPI 1285299032
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699920000000",
"number": "1295509859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5050 RUM CREEK CT SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495085280",
"telephone_number": "616-633-0994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5020 E BELTLINE AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495256869",
"telephone_number": "616-439-1866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEZERN",
"first_name": "PHILIP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-14",
"last_updated": "2023-11-14",
"certification_date": "2023-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851093862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.