Individual provider Active NPI

Shannon E McKeever

  • Social Worker
  • Port Huron, MI
National Provider Identifier
1629370101
Registry record updated Dec 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
3111 Electric Ave
Port Huron, MI 48060-8127
Phone
(810) 985-8900
NPI assigned
Dec 3, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2010

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 Primary

Addresses

Primary practice location

3111 Electric Ave
Port Huron, MI 48060-8127

Mailing address

3857 Krafft Rd
Fort Gratiot, MI 48059-3712
Phone (810) 982-1974

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
I20130325000546 MI Practitioner - Clinical Social Worker 6103061007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Blue Water Mental Health ClinicGroup PAC ID 2769477264, 23 clinicians

Practice addresses (Care Compare)

1501 Krafft Rd
Fort Gratiot, MI 48059-3565
Phone (810) 985-5125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Water Mental Health Clinic CurrentSince Jun 1, 2019 Accepting new patients
NPI 1891833810 CurrentSince Jun 1, 2019 Accepting new patients

Locations

1501 Krafft Rd
Fort Gratiot, MI 48059
Phone (810) 985-5125

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": "1291334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291334400000",
    "number": "1629370101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 KRAFFT RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593712",
            "telephone_number": "810-982-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-985-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKEEVER",
        "first_name": "SHANNON",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-03",
        "last_updated": "2010-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.