Susan Diane Blackburn, LMSW
Individual provider Active NPI Clinical Social Worker · North Muskegon, MI
NPI 1649512484 · NPPES record last updated Aug 19, 2022
Key facts
- NPI
- 1649512484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801079604 (MI)
- Practice address
- 2006 Holton Rd
North Muskegon, MI 49445-1505 - Phone
- (231) 672-3333
- NPI assigned
- Mar 19, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
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 |
|---|---|---|---|---|
| I20130503000456 | MI | Practitioner - Clinical Social Worker | 3870730161 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801079604 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Health Saint Mary'S Medical Group | Current |
Accepting new patients |
Locations
10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850
245 Cherry St SE
Ste 100
Grand Rapids, MI 49503
Phone (616) 685-3200
1500 E Sherman Blvd
Muskegon, MI 49444
Phone (231) 672-3027
1223 Mercy Dr
Muskegon, MI 49444
Phone (231) 672-3177
2006 Holton Rd
North Muskegon, MI 49445
Phone (231) 672-3333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801079604 | MI | Yes |
Addresses
Primary practice location
2006 Holton Rd
North Muskegon, MI 49445-1505
Mailing address
PO Box 776974
Chicago, IL 60677-6974
Phone (231) 672-2119
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649512484 | Medicaid | MI |
Other names
- Miss Susan Diane Gasper
Other providers in North Muskegon, MI
- Apex Drug Stores Inc
- Atrium Hillcrest LLC
- Bethany M Bartos
- Meagan Frances Bergquist
- Peter William Blackburn
- Thompson Greig Boyd
- Michelle Lee Burkhardt Bullion
- Heather M. Burnside
- Megan Campbell
- Trisha Cesaretti
All providers in North Muskegon, 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 Aug 19, 2022. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.