Katie Lynn Green, LMSW
Individual provider Active NPI Clinical Social Worker · Ada, MI
NPI 1306509013 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1306509013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801112387 (MI)
- Practice address
- 7128 Fulton St E
Ada, MI 49301-8413 - Phone
- (616) 825-3530
- NPI assigned
- Oct 19, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Spectrum Health Primary Care Partners
Practice addresses (Care Compare)
4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600
7128 Fulton St E
Corewell Health Medical Group West
Ada, MI 49301-8413
Phone (616) 825-3559
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211103001748 | MI | Practitioner - Clinical Social Worker | 5193113595 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801112387 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spectrum Health Primary Care Partners | Current |
Accepting new patients | |
| Spectrum Health Primary Care Partners | Current |
Accepting new patients | |
| Virtuwell Therapy, LLC | Past |
Accepting new patients |
Locations
7128 Fulton St E
Ada, MI 49301
Phone (616) 825-3500
100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242
3152 Port Sheldon St
Ste C
Hudsonville, MI 49426
Phone (616) 669-9238
4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801112387 | MI | Yes |
Addresses
Primary practice location
7128 Fulton St E
Ada, MI 49301-8413
Mailing address
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Other providers in Ada, MI
- Robert Labadie Funaro
- Guy J Garrett
- Leonard Samuel Gell
- Lauraann Terry Gordon
- Chantel Dobb Grant
- Brian Lynn Gripentrog
- Susan Lesli Hall
- Denise Marie Hames
- Rebecca Hamm Martin
- Rickie Vance Hay
All providers in Ada, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.