Individual provider Active NPI

Lisa J. Griffin, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1598765992
Registry record updated May 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801057233 Issued in MI
Practice address
2060 East Paris Ave SE
Suite 220
Grand Rapids, MI 49546
Phone
(616) 940-0238
Fax
(616) 285-7211
NPI assigned
Jul 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801057233 MI Primary

Addresses

Primary practice location

2060 East Paris Ave SE
Suite 220
Grand Rapids, MI 49546

Mailing address

61 Commerce Ave SW
Grand Rapids, MI 49503
Phone (616) 940-0660

Other names 1

  • Miss Lisa Goodman Former name

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
I20101130000888 MI Practitioner - Clinical Social Worker 7911193198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

1870 Leonard St NE
Christian Counseling Center Ministry of Pin
Grand Rapids, MI 49505-5650
Phone (616) 956-9619

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801057233MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Jun 22, 2017 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jun 22, 2017 Accepting new patients

Locations

1870 Leonard St NE
Grand Rapids, MI 49505
Phone (616) 956-1122

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

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": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337040000000",
    "number": "1598765992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 COMMERCE AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-940-0660",
            "fax_number": "616-940-1965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 EAST PARIS AVE SE",
            "address_2": "SUITE 220",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-940-0238",
            "fax_number": "616-285-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIFFIN",
        "first_name": "LISA",
        "middle_name": "J.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-28",
        "last_updated": "2012-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801057233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "GOODMAN",
            "prefix": "MISS",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.