Active NPI
Phyllis Ruth Roelofs
- Clinical Social Worker
- Warren, MI
National Provider Identifier
1649314956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801060243
- Practice address
- 4426 Wisteria CT
Warren, MI 48092-6116 - Phone
- (248) 459-2002
- Fax
- (586) 574-0389
- NPI assigned
- Feb 19, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801060243 | MI | Primary |
Addresses
Primary practice location
4426 Wisteria CT
Warren, MI 48092-6116
Mailing address
4426 Wisteria CT
Warren, MI 48092-6116
Phone (248) 459-2002
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8009078570 | Other | MI | BLUECROSSBLUESHIELD |
| 040252 | Other | MI | VALUEOPTIONS |
Other names 1
- Mrs. Phyllis Ruth Roelofs
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801060243 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Birgit Amann M D P L L C | Past | Accepting new patients |
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.
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- NPI 1346417797
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392249600000",
"number": "1649314956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4426 WISTERIA CT",
"city": "WARREN",
"state": "MI",
"postal_code": "480926116",
"telephone_number": "248-459-2002",
"fax_number": "586-574-0389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4426 WISTERIA CT",
"city": "WARREN",
"state": "MI",
"postal_code": "480926116",
"telephone_number": "248-459-2002",
"fax_number": "586-574-0389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROELOFS",
"first_name": "PHYLLIS",
"middle_name": "RUTH",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-19",
"last_updated": "2014-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801060243",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "8009078570",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "040252",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PHYLLIS",
"last_name": "ROELOFS",
"middle_name": "RUTH",
"prefix": "MRS.",
"credential": "LCSW",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.