Individual provider Active NPI

Tony Lewis Emerson, LMSW

  • Social Worker
  • Grand Rapids, MI
National Provider Identifier
1316399496
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801104283 Issued in MI
Practice address
640 3 Mile Rd NW Ste G
Grand Rapids, MI 49544-8209
Phone
(616) 369-8433
NPI assigned
Jul 12, 2016
Last updated
Aug 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801104283 MI Primary

Addresses

Primary practice location

640 3 Mile Rd NW Ste G
Grand Rapids, MI 49544-8209

Mailing address

555 Fremont Ave NW Apt 1
Grand Rapids, MI 49504-5117
Phone (616) 419-9289

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
I20190613003217 MI Practitioner - Clinical Social Worker 6002149614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Richard Kneip PHD PCGroup PAC ID 4880768415, 243 clinicians

Practice addresses (Care Compare)

640 3 Mile Rd NW G
Great Lakes Psychology Group
Grand Rapids, MI 49544-8209
Phone (800) 693-1916

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801104283MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Kneip, PH.D., P.C. CurrentSince Jul 20, 2021 Accepting new patients

Locations

89 W South Blvd
Ste 200
Troy, MI 48085
Phone (248) 813-8840

640 3 Mile Rd NW
Ste G
Walker, MI 49544
Phone (517) 234-3826

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, 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": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1316399496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 FREMONT AVE NW APT 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495045117",
            "telephone_number": "616-419-9289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 3 MILE RD NW STE G",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495448209",
            "telephone_number": "616-369-8433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMERSON",
        "first_name": "TONY",
        "middle_name": "LEWIS",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-12",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801104283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.