Individual provider Active NPI

Elizabeth A Peters, LMSW

  • Clinical Social Worker
  • Portage, MI
National Provider Identifier
1609342799
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6851108254 Issued in MI
Practice address
1350 W Centre Ave
Portage, MI 49024-5361
Phone
(269) 910-7327
NPI assigned
Oct 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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 6851108254 MI Primary

Addresses

Primary practice location

1350 W Centre Ave
Portage, MI 49024-5361

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927

Other identifiers 1

IdentifierTypeStateIssuer
6802090122OtherMILICENSE NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Pinerestcmhs@directaddress.pinerest.org Direct

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
I20230923000278 MI Practitioner - Clinical Social Worker 4082068119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

1350 W Centre Ave
210 Pine Rest Portage Clinic
Portage, MI 49024-5361
Phone (269) 910-7327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6851108254MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Aug 29, 2023 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Aug 29, 2023 Accepting new patients
Pine Rest Christian Mental Health Services PastSince Dec 31, 2023 Accepting new patients

Locations

1350 W Centre Ave
Portage, MI 49024
Phone (269) 910-7327

1350 W Centre Ave
Ste 210
Portage, MI 49024
Phone (269) 910-7327

7895 Currier Dr
Ste 100
Portage, MI 49002
Phone (269) 910-7327

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

Organizations & group practices 3

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": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1609342799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245361",
            "telephone_number": "269-910-7327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-16",
        "last_updated": "2023-12-28",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851108254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "6802090122",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Pinerestcmhs@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.