NPIMap

Organization Active NPI

Life Support LLC

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1437518875
Registry record updated Feb 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LIFE SUPPORT LLC
Practice address
5270 Northland Dr NE
Grand Rapids, MI 49525-1073
Phone
(616) 690-0556
NPI assigned
Feb 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2016

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

Authorized official

Name
Jason Clauser, LMSWNPI 1629397823
Title
Owner
Phone
(616) 690-0556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

5270 Northland Dr NE
Grand Rapids, MI 49525-1073

Mailing address

PO Box 10
Mason, MI 48854-0010
Phone (517) 676-9788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161110002703 MI Part B Supplier - Clinic/Group Practice 8527347756 Receives reassigned benefits from 6 practitioners
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

2730 5 Mile Rd NE
Ste 101
Grand Rapids, MI 49525
Phone (616) 426-9401

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1455321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455321600000",
    "number": "1437518875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488540010",
            "telephone_number": "517-676-9788",
            "fax_number": "517-676-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5270 NORTHLAND DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251073",
            "telephone_number": "616-690-0556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-13",
        "last_updated": "2016-02-13",
        "status": "A",
        "authorized_official_last_name": "CLAUSER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-690-0556",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.