Individual provider Active NPI

Angelique S Gierszewski, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1639508989
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801099750 Issued in MI
Practice address
320 Commerce Ave SW
Grand Rapids, MI 49503-4101
Phone
(616) 258-7599
Fax
(616) 222-4571
NPI assigned
Nov 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 4521 ND
Clinical Social Worker 1041C0700X 6801099750 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) 258-7599

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
I20161116001071 MI Practitioner - Clinical Social Worker 5092946202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of North Dakota School of Medicine, 2010
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)

320 Commerce Ave SW
Pine Rest Demay Clinic
Grand Rapids, MI 49503-4101
Phone (616) 258-7599

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4521NDMDSocial Worker
6801099750MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services Social Worker CurrentSince Nov 1, 2016 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Nov 1, 2016 Accepting new patients

Locations

320 Commerce Ave SW
Grand Rapids, MI 49503
Phone (616) 222-4570

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": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1639508989",
    "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": "616-258-7599",
            "fax_number": "616-222-4571"
        },
        {
            "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": "616-258-7599",
            "fax_number": "616-222-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIERSZEWSKI",
        "first_name": "ANGELIQUE",
        "middle_name": "S",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "4521",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801099750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.