Individual provider Active NPI

Bradley Baker, LLMSW

  • Clinical Social Worker
  • Ypsilanti, MI
National Provider Identifier
1386207967
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6851103794 Issued in MI
Practice address
555 Towner St
Ypsilanti, MI 48198-5723
Phone
(734) 891-5546
Fax
(734) 544-2906
NPI assigned
Apr 18, 2019
Last updated
Jan 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6851103794 MI Primary

Addresses

Primary practice location

555 Towner St
Ypsilanti, MI 48198-5723

Mailing address

555 Towner St
Ypsilanti, MI 48198-5723
Phone (734) 544-3000

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
I20220720003298 MI Practitioner - Clinical Social Worker 0749661080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bay Mills Indian CommunityGroup PAC ID 8729079918, 13 clinicians
Community Mental Health Services of St Joseph CountyGroup PAC ID 9032178496, 17 clinicians

Practice addresses (Care Compare)

12455 W Lakeshore Dr
Brimley, MI 49715-9327
Phone (906) 248-5527

677 E Main St
Centreville, MI 49032-8524
Phone (269) 467-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Mills Indian Community Current Accepting new patients
Bay Mills Indian Community CurrentSince Jun 29, 2022 Accepting new patients
Community Mental Health Services of St Joseph County CurrentSince Aug 2, 2022 Accepting new patients
Bay Mills Indian Community CurrentSince Jun 29, 2022 Accepting new patients
County of Washtenaw Past Accepting new patients
County of Washtenaw PastSince Jul 8, 2019 Accepting new patients

Locations

12455 W Lakeshore Dr
Brimley, MI 49715
Phone (906) 248-5527

677 E Main St
Centreville, MI 49032
Phone (269) 467-1001

677 E Main St
Ste A
Centreville, MI 49032
Phone (269) 467-1001

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1386207967",
    "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": "481985723",
            "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": "555 TOWNER ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481985723",
            "telephone_number": "734-891-5546",
            "fax_number": "734-544-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "BRADLEY",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-18",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851103794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.