Active NPI
Timothy John Pegman, LBSW
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1619360278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802085817
- Practice address
- 320 Commerce Ave SW
Grand Rapids, MI 49503-4101 - Phone
- (616) 222-4570
- NPI assigned
- Mar 6, 2015
- Last updated
- Mar 6, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802085817 | MI | Primary |
Addresses
Primary practice location
320 Commerce Ave SW
Grand Rapids, MI 49503-4101
Mailing address
320 Commerce Ave SW
Grand Rapids, MI 49503-4101
Phone (616) 222-4570
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6802085817 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425600000000",
"number": "1619360278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 COMMERCE AVE SW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034101",
"telephone_number": "616-222-4570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 COMMERCE AVE SW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034101",
"telephone_number": "616-222-4570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEGMAN",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"credential": "LBSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-06",
"last_updated": "2015-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802085817",
"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 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.