Active NPI
Timothy Paul Kolbasa
- Social Worker
- Ann Arbor, MI
National Provider Identifier
1356895262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801099906
- Practice address
- 110 N 4TH Ave
Ann Arbor, MI 48104-5503 - Phone
- (734) 544-3000
- NPI assigned
- Aug 9, 2016
- Sex
- Male
- 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 | 6801099906 | MI | Primary |
Addresses
Primary practice location
110 N 4TH Ave
Ann Arbor, MI 48104-5503
Mailing address
555 Towner St
Ypsilanti, MI 48198-5752
Phone (734) 544-3000
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 |
|---|---|---|---|
| 6801099906 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Washtenaw | Past | Accepting new patients | |
| County of Washtenaw | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- State or Local Public Health Clinic/Center
- Ypsilanti, MI
- NPI 1609896018
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Ypsilanti, MI
- NPI 1639132442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1356895262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 TOWNER ST",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481985752",
"telephone_number": "734-544-3000",
"fax_number": "734-544-6716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 N 4TH AVE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481045503",
"telephone_number": "734-544-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLBASA",
"first_name": "TIMOTHY",
"middle_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-09",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801099906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.