Charlie Murphy Gantt, NP, AGPRN, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Farmington Hills, MI
NPI 1346861440 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1346861440
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 4704317868 (MI)
- Practice address
- 32905 W 12 Mile Rd
Farmington Hills, MI 48334-3342 - Phone
- (248) 957-9184
- Fax
- (248) 957-9185
- NPI assigned
- Apr 29, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Alcona Citizens for Health Inc
Counseling Center of West Michigan LLC
Practice addresses (Care Compare)
11745 US Hwy 23 S
Alcona Health Centers Ossineke Ser
Ossineke, MI 49766-9582
Phone (989) 471-2156
316 Morris Ave
Suite 200
Muskegon, MI 49440-1154
Phone (616) 805-3660
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200612000759 | MI | Practitioner - Nurse Practitioner | 8426470865 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704317868 | MI | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling Center of West Michigan, LLC | Current |
Accepting new patients | |
| Virtuwell Therapy, LLC | Past |
Accepting new patients | |
| Advanced Veins and Vascular Management PLC | Past | Accepting new patients |
Locations
333 Bridge St NW
Ste 1120
Grand Rapids, MI 49504
Phone 61680536601005
360 E Beltline Ave NE
Ste 100
Grand Rapids, MI 49506
Phone (616) 566-1021
316 Morris Ave
Ste 200
Muskegon, MI 49440
Phone (616) 204-8984
65 S Main St
Ste A
Rockford, MI 49341
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EIBIBD
- charlie.gantt.p1@direct.alcona.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 4704317868 | MI | |
| Primary Care Nurse Practitioner | 363LP2300X | 4704317868 | MI | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 4704317868 | MI | Yes |
Addresses
Primary practice location
32905 W 12 Mile Rd
Farmington Hills, MI 48334-3342
Mailing address
1922 Forest View CT
Commerce Township, MI 48390-3943
Phone (248) 762-8017
Other providers in Farmington Hills, MI
- Alyssa Gansert
- Patricia Ganski
- Carrington Elizabeth Gant
- Desiree Gant
- Jeanessa Gant
- Marcus Gantz
- Andrea Gaona
- Sierra Gaona
- Robert Gape
- Mavis Gappy
All providers in Farmington Hills, MI · Psychiatric/Mental Health Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. 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.