Individual provider Active NPI

Christopher Sanjurjo Montalvo, LLMSW

  • Social Worker
  • Grand Rapids, MI
National Provider Identifier
1538708276
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801108355 Issued in MI
Practice address
440 Baltimore Dr NE
Grand Rapids, MI 49503-3934
Phone
(616) 301-8000
NPI assigned
Dec 28, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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 6801108355 MI
Social Worker 104100000X 6801108355 MI Primary

Addresses

Primary practice location

440 Baltimore Dr NE
Grand Rapids, MI 49503-3934

Mailing address

825 Leonard St NE
Grand Rapids, MI 49503-1177
Phone (616) 301-8000

Other practice location 1

5635 W Fort St
Detroit, MI 48209-3154
Phone (313) 849-3920

Other practice location 2

17160 130th Ave
Nunica, MI 49448-9450
Phone (616) 847-4460

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6801108355MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hope Network Behavioral Health Services Social Worker CurrentSince May 1, 2022 Accepting new patients

Locations

385 Leonard St NE
Grand Rapids, MI 49503
Phone (616) 454-4777

825 Leonard St NE
Grand Rapids, MI 49503
Phone (616) 200-4358

17160 130th Ave
Nunica, MI 49448
Phone (616) 298-8190

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.

NPI Registry JSON

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

{
    "created_epoch": "1577491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1538708276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 LEONARD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031177",
            "telephone_number": "616-301-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 BALTIMORE DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033934",
            "telephone_number": "616-301-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5635 W Fort St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482093154",
            "country_code": "US",
            "telephone_number": "313-849-3920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17160 130th Ave",
            "address_purpose": "LOCATION",
            "city": "Nunica",
            "state": "MI",
            "postal_code": "494489450",
            "country_code": "US",
            "telephone_number": "616-847-4460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANJURJO MONTALVO",
        "first_name": "CHRISTOPHER",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-28",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801108355",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801108355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.