Individual provider Active NPI

Marit Johanne Bucknam, MSW

  • Social Worker
  • Livonia, MI
National Provider Identifier
1467502435
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
18316 Middlebelt Rd
Livonia, MI 48152-5007
Phone
(248) 615-9730
NPI assigned
Jan 11, 2007
Last updated
Jan 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 6801046626 MI
Social Worker 104100000X Primary

Addresses

Primary practice location

18316 Middlebelt Rd
Livonia, MI 48152-5007

Mailing address

2896 Barclay Way
Ann Arbor, MI 48105-9455
Phone (734) 222-6269

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
I20110822000073 MI Practitioner - Clinical Social Worker 7113197690 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5361 McAuley Dr
Ypsilanti, MI 48197-1011
Phone (734) 712-1300

5401 McAuley Dr
Ypsilanti, MI 48197-1011
Phone (734) 786-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801046626MIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Service Corporation CurrentSince Jul 1, 2023 Accepting new patients
St Mary Mercy Hospital Professional Current Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Services Corporation CurrentSince Jul 1, 2023 Accepting new patients
St Mary Mercy Hospital Professional CurrentSince Mar 14, 2015 Accepting new patients
St Mary Mercy Hospital Crna Current Accepting new patients
St Joseph Mercy Hospital Current Accepting new patients
St Joseph Mercy Hospital CurrentSince Aug 7, 2021 Accepting new patients
St Joseph Mercy Hospital CurrentSince Aug 7, 2021 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

36475 5 Mile Rd
Livonia, MI 48154
Phone (734) 464-4800

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

5361 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-1300

Organizations & group practices 9

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": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451952000000",
    "number": "1467502435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2896 BARCLAY WAY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059455",
            "telephone_number": "734-222-6269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18316 MIDDLEBELT RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481525007",
            "telephone_number": "248-615-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKNAM",
        "first_name": "MARIT",
        "middle_name": "JOHANNE",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2016-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6801046626",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.