Individual provider Active NPI

Martin Randal Heggestad, SW

  • Social Worker
  • Ann Arbor, MI
National Provider Identifier
1356560411
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801087110 Issued in MI
Practice address
4250 Plymouth Rd
Ann Arbor, MI 48109
Phone
(734) 764-6443
NPI assigned
Apr 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 6801087110 MI Primary

Addresses

Primary practice location

4250 Plymouth Rd
Ann Arbor, MI 48109

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

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
I20100317001100 MI Practitioner - Clinical Social Worker 3779618517 Reassigns benefits to 1 organization
Practice locations: Ann Arbor, MI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

1000 Wall St
Ann Arbor, MI 48105-1912
Phone (734) 764-4190

4250 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 764-0231

4260 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 764-6831

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801087110MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Dec 28, 2009 Accepting new patients
Regents of the University of Michigan Social Worker CurrentSince Dec 28, 2009 Accepting new patients
Sarah Talgo Therapy LLC PastSince Aug 24, 2016 Accepting new patients

Locations

4250 Plymouth Rd
Ann Arbor, MI 48109
Phone (734) 764-0231

3621 S State St
#700
Ann Arbor, MI 48108

1000 Wall St
Ann Arbor, MI 48105
Phone (734) 763-1415

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356560411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 PLYMOUTH RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48109",
            "telephone_number": "734-764-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEGGESTAD",
        "first_name": "MARTIN",
        "middle_name": "RANDAL",
        "credential": "SW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801087110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.