Diane Bruursema, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801067679 Issued in MI

Practice address

12265 James St
Holland, MI 49424-8613

Phone

(616) 494-5453

NPI assigned

Aug 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lakeshore Integrative Mental Health Services, LLC

  • Clinical Social Worker
  • Norton Shores, MI
  • NPI 1447644471
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487762175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12265 JAMES ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248613",
            "telephone_number": "616-494-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12265 JAMES ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248613",
            "telephone_number": "616-494-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUURSEMA",
        "first_name": "DIANE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801067679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Bruining, RPH
• Taylor Bruinsma, NP
• Kirk Alan Brumels, PHD, ATC
• Lisa Brunette
• Dominique Nicole Brusven
• Payton Bruursema
• Robert J Bruxvoort, M.D.
• Susan Buist, LMSW
• Christy Buitendorp-Bellaoud
• Angela Burch, PA-C

• Clinical Social Worker in Holland, MI
• Providers in Holland, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.