Kimberly Rose Peltz, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

68011091399 Issued in MI

Practice address

1501 Krafft Rd
Fort Gratiot, MI 48059-3565

Phone

(810) 985-5825

NPI assigned

Aug 5, 2009

Sex

Female

Sole proprietor

Yes

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

Specialty

Clinical Social Worker

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blue Water Mental Health ClinicGroup PAC ID 2769477264, 23 clinicians

Practice addresses (Care Compare)

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.

• Blue Water Mental Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Gratiot, MI
  • NPI 1457305419

  Clinical

  Medicare reassignment Care Compare group NPD
• Blue Water Mental Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brockway, MI
  • NPI 1467590406

  Clinical

  NPD (past)

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

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1497986616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4314 CRIBBINS RD",
            "city": "CLYDE",
            "state": "MI",
            "postal_code": "480492809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KRAFFT RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593565",
            "telephone_number": "810-985-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELTZ",
        "first_name": "KIMBERLY",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-05",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "68011091399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nevaeha Lashae Marie Pasvantis
• Mark Paulus
• Chelsea Payne
• Antoinetta Payton-Robinson
• Pcor LLC
• Jerrie Michele Pemberton, OTR
• Amanda Michelle Penley
• Marie Peterson, OD
• Jennifer Ann Peyerk, P.T.
• Katherine Ann Phelan, M.A., CCC-SLP

• Clinical Social Worker in Fort Gratiot, MI
• Providers in Fort Gratiot, 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 Dec 4, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.