Active NPI
Kimberly Lee
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1306565072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851105408
- Practice address
- 2100 Raybrook St SE Ste 203
Grand Rapids, MI 49546-5783 - Phone
- (616) 956-9440
- NPI assigned
- Aug 25, 2022
- Sex
- Female
- 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 | 6851105408 | MI | Primary |
Addresses
Primary practice location
2100 Raybrook St SE Ste 203
Grand Rapids, MI 49546-5783
Mailing address
5722 Willow Creek Dr
Saranac, MI 48881-8723
Phone (616) 822-1031
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kimberly.lee@relianceccp.org | Reliance Community Care Partners |
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 |
|---|---|---|---|
| 6851105408 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661385600000",
"number": "1306565072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5722 WILLOW CREEK DR",
"city": "SARANAC",
"state": "MI",
"postal_code": "488818723",
"telephone_number": "616-822-1031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 RAYBROOK ST SE STE 203",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495465783",
"telephone_number": "616-956-9440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-25",
"last_updated": "2022-08-25",
"certification_date": "2022-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851105408",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kimberly.lee@relianceccp.org",
"affiliation": "Y",
"affiliationName": "Reliance Community Care Partners",
"address_1": "2100 Raybrook SE",
"address_2": "Suite 203",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495465783",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Aug 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.