NPIMap

Individual provider Active NPI

Miguel Ricardo Quintanilla, LMSW

  • Social Worker
  • Grand Rapids, MI
National Provider Identifier
1598097958
Registry record updated Mar 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801091225 Issued in MI
Practice address
3501 Lake Eastbrook Blvd SE
#258
Grand Rapids, MI 49546-5938
Phone
(616) 719-0194
Fax
(800) 219-5205
NPI assigned
Feb 9, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801091225 MI Primary

Addresses

Primary practice location

3501 Lake Eastbrook Blvd SE
#258
Grand Rapids, MI 49546-5938

Mailing address

3501 Lake Eastbrook Blvd SE
#258
Grand Rapids, MI 49546-5938
Phone (616) 719-0194

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
6801091225MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Adolescent and Family Behavioral Health Services Past Accepting new patients

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": "1265673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395014400000",
    "number": "1598097958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 LAKE EASTBROOK BLVD SE",
            "address_2": "#258",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465938",
            "telephone_number": "616-719-0194",
            "fax_number": "800-219-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 LAKE EASTBROOK BLVD SE",
            "address_2": "#258",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465938",
            "telephone_number": "616-719-0194",
            "fax_number": "800-219-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINTANILLA",
        "first_name": "MIGUEL",
        "middle_name": "RICARDO",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-09",
        "last_updated": "2014-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801091225",
            "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 Mar 17, 2014; 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.