Active NPI
Chalisa Sharise-Renee Phipps
- Social Worker
- Detroit, MI
National Provider Identifier
1376847442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- P120115765767
- Practice address
- 79 W. Alexandrine
Detroit, MI 48201 - Phone
- (313) 831-5535
- Fax
- (313) 831-2608
- NPI assigned
- Jan 4, 2011
- Sex
- Female
- 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 | P120115765767 | MI | Primary |
Addresses
Primary practice location
79 W. Alexandrine
Detroit, MI 48201
Mailing address
79 W. Alexandrine
Detroit, MI 48201
Phone (313) 831-5535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6801094959 | Other | MI | MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS |
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 |
|---|---|---|---|
| P120115765767 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425600000000",
"number": "1376847442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 W. ALEXANDRINE",
"city": "DETROIT",
"state": "MI",
"postal_code": "48201",
"telephone_number": "313-831-5535",
"fax_number": "313-831-2608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 W. ALEXANDRINE",
"city": "DETROIT",
"state": "MI",
"postal_code": "48201",
"telephone_number": "313-831-5535",
"fax_number": "313-831-2608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHIPPS",
"first_name": "CHALISA",
"middle_name": "SHARISE-RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-04",
"last_updated": "2015-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "P120115765767",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS",
"identifier": "6801094959",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.