Active NPI
Jhenna Jamal Vantimmeren
- Clinical Social Worker
- Grand Rapids, MI
National Provider Identifier
1659097038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801115624
- Practice address
- 710 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2379 - Phone
- (855) 284-7483
- Fax
- (617) 807-0958
- NPI assigned
- Oct 17, 2022
- Last updated
- Mar 1, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | MI | ||
| Clinical Social Worker | 1041C0700X | 6801115624 | MI | Primary |
Addresses
Primary practice location
710 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2379
Mailing address
PO Box 748465
Atlanta, GA 30374-8465
Phone (855) 284-7483
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
630 Kenmoor Ave SE
Suite 101B
Grand Rapids, MI 49546-8626
Phone (231) 888-1681
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801115624 | MI | MD | Clinical Social Worker |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677628800000",
"number": "1659097038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 748465",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303748465",
"telephone_number": "855-284-7483",
"fax_number": "617-807-0958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 KENMOOR AVE SE STE 100",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462379",
"telephone_number": "855-284-7483",
"fax_number": "617-807-0958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANTIMMEREN",
"first_name": "JHENNA",
"middle_name": "JAMAL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-17",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801115624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.