Individual provider Active NPI

Gerald Duane Joubert, LBSW

  • Social Worker
  • Ionia, MI
National Provider Identifier
1356635403
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6802064503 Issued in MI
Practice address
375 Apple Tree Dr
Ionia, MI 48846-7506
Phone
(616) 527-1790
Fax
(616) 527-0538
NPI assigned
Jun 7, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

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 6802064503 MI Primary

Addresses

Primary practice location

375 Apple Tree Dr
Ionia, MI 48846-7506

Mailing address

1508 144TH Ave
Dorr, MI 49323-9748
Phone (616) 902-4731

Other identifiers 1

IdentifierTypeStateIssuer
1715928MedicaidMI

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
I20221103000306 MI Practitioner - Clinical Social Worker 6406223551 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
Group practices
Ionia County Community Mental HealthGroup PAC ID 4880598325, 17 clinicians

Practice addresses (Care Compare)

375 Apple Tree Dr
Ionia, MI 48846-7506
Phone 61652717901142

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6802064503MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ionia County Community Mental Health CurrentSince Oct 4, 2022 Accepting new patients

Locations

7441 Storey Rd
Belding, MI 48809
Phone (616) 361-5001

375 Apple Tree Dr
Ionia, MI 48846
Phone (616) 527-1790

375 Apple Tree Dr
#H
Ionia, MI 48846
Phone (616) 527-1790

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307404800000",
    "number": "1356635403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 144TH AVE",
            "city": "DORR",
            "state": "MI",
            "postal_code": "493239748",
            "telephone_number": "616-902-4731",
            "fax_number": "616-527-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 APPLE TREE DR",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488467506",
            "telephone_number": "616-527-1790",
            "fax_number": "616-527-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOUBERT",
        "first_name": "GERALD",
        "middle_name": "DUANE",
        "credential": "LBSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-07",
        "last_updated": "2011-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802064503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1715928",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ionia, MI

Sources for this page

Verify at the official NPI Registry.