Thomas Edgar Johnson, LMSW
Individual provider Active NPI Clinical Social Worker · Brownstown TWP, MI
NPI 1639436173 · NPPES record last updated Apr 23, 2012
Key facts
- NPI
- 1639436173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801011164 (MI)
- Practice address
- 19366 Allen Rd Ste C
Brownstown TWP, MI 48183-6810 - Phone
- (734) 479-0949
- Fax
- (734) 479-1637
- NPI assigned
- Apr 23, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Apex Behavioral Health Western Wayne
Practice addresses (Care Compare)
1547 S Wayne Rd
Westland, MI 48186-5436
Phone 7347293133117
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120808000251 | MI | Practitioner - Clinical Social Worker | 8325934136 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801011164 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apex Behavioral Health Western Wayne | Clinical | Current |
Accepting new patients |
| Apex Downriver Behavioral Health | Clinical | Past | Accepting new patients |
Locations
1547 S Wayne Rd
Westland, MI 48186
Phone (734) 729-3133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801011164 | MI | Yes |
Addresses
Primary practice location
19366 Allen Rd Ste C
Brownstown TWP, MI 48183-6810
Mailing address
9351 Willow Rd
Willis, MI 48191-9725
Phone (734) 461-6447
Other providers in Brownstown TWP, MI
- Hassan Jafer
- Syed Sadiq Mohammed Jafri
- James W Hill
- Hiba Jawadi
- Derek Alan Johnson
- Junita Bahroos, DDS
- Diane Jean Kaip
- Kamal Gupta, M.D. P.C.
- Young Kil Kim
- King Medical Center
All providers in Brownstown TWP, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.