Individual provider Active NPI

Robert Louis Cheetham, LMSW

  • Clinical Social Worker
  • Lincoln Park, MI
National Provider Identifier
1447397104
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801087233 Issued in MI
Practice address
26184 Outer Dr
Lincoln Park, MI 48146-2084
Phone
(313) 389-7500
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 6801087233 MI Primary

Addresses

Primary practice location

26184 Outer Dr
Lincoln Park, MI 48146-2084

Mailing address

23312 Couzens Ave
Hazel Park, MI 48030-1510
Phone (248) 542-6398

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
I20260501000344 MI Practitioner - Clinical Social Worker 4789151374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2003
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

812 E Jolly Rd
Lansing, MI 48910-6818

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801087233MIMDClinical Social Worker

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447397104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23312 COUZENS AVE",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480301510",
            "telephone_number": "248-542-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26184 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-389-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEETHAM",
        "first_name": "ROBERT",
        "middle_name": "LOUIS",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801087233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln Park, MI

Sources for this page

Verify at the official NPI Registry.