Active NPI
Agnes Bacon, LMSW
- Clinical Social Worker
- Muskegon, MI
National Provider Identifier
1457020810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801100310
- Practice address
- 1440 E Sherman Blvd Ste 300
Muskegon, MI 49444-1816 - Phone
- (231) 672-2008
- Fax
- (231) 672-2009
- NPI assigned
- Sep 9, 2021
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801100310 | MI | Primary |
Addresses
Primary practice location
1440 E Sherman Blvd Ste 300
Muskegon, MI 49444-1816
Mailing address
PO Box 776982
Chicago, IL 60677-6982
Phone (231) 672-2119
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801100310 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Partners | Past | Accepting new patients |
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.
-
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- NPI 1154910172
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677628800000",
"number": "1457020810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 776982",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606776982",
"telephone_number": "231-672-2119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 E SHERMAN BLVD STE 300",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494441816",
"telephone_number": "231-672-2008",
"fax_number": "231-672-2009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "AGNES",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-09",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801100310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.