Individual provider Active NPI

Nichole Amber Smith

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1467065409
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801118649 Issued in MI
Practice address
100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone
(616) 965-8200
NPI assigned
Aug 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6851110906 MI
Clinical Social Worker 1041C0700X 6801118649 MI Primary

Addresses

Primary practice location

100 Cherry St SE
Grand Rapids, MI 49503-4526

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone (616) 965-8200

Other practice location 1

1346 Baldwin St
Jenison, MI 49428-8937
Phone (616) 765-8585

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
I20250825001431 MI Practitioner - Clinical Social Worker 4587164413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Street Services IncGroup PAC ID 6800707647, 58 clinicians

Practice addresses (Care Compare)

100 Cherry St SE
Grand Rapids, MI 49503-4526

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6851110906MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cherry Street Services, Inc. CurrentSince Jul 22, 2025 Accepting new patients
Cherry Street Services, Inc Clinical CurrentSince Jul 22, 2025 Accepting new patients
Tahoma Enterprises LLC Clinical PastSince Jul 16, 2023 Accepting new patients

Locations

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

Interoperability endpoints

  • Direct secure messaging: nichole.smith.p1@direct.cherryhealth.nextgenshare.com

Organizations & group practices 3

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": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1467065409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1346 Baldwin St",
            "address_purpose": "LOCATION",
            "city": "Jenison",
            "state": "MI",
            "postal_code": "494288937",
            "country_code": "US",
            "telephone_number": "616-765-8585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "NICHOLE",
        "middle_name": "AMBER",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851110906",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801118649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.