Michael Shock, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4694 Issued in ND

Practice address

200 Highway 2 W
Devils Lake, ND 58301-3532

Phone

(701) 665-2200

Fax

(701) 665-2300

NPI assigned

Mar 13, 2007

Last updated

Oct 27, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Region Human Service CenterGroup PAC ID 8426941436, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Lake Region Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Devils Lake, ND
  • NPI 1669411930
  Medicare reassignment Care Compare group NPD
• Lifewise Associates LLC

  • Clinic/Center
  • Devils Lake, ND
  • NPI 1871088674
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509062400000",
    "number": "1659404556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583010650",
            "telephone_number": "701-665-2200",
            "fax_number": "701-665-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HIGHWAY 2 W",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013532",
            "telephone_number": "701-665-2200",
            "fax_number": "701-665-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCK",
        "first_name": "MICHAEL",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2017-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "4694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1456526",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Senior Meals & Services
• Brenda Severson
• James Shaw
• Tyra Shaw
• Kelsey Sherry
• Lisa Shuster
• Chelsey Simonsen, LAC
• Danielle Don Skaar, FNP-C
• Lindsey Skavhaug
• Dianna Skold, LSW

• Clinical Social Worker in Devils Lake, ND
• Providers in Devils Lake, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2017; 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.

Verify at the official NPI Registry.