Active NPI
Jeffery Deitrick
- Clinical Social Worker
- Midland, MI
National Provider Identifier
1659989705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801092058
- Practice address
- 1205 E Wackerly St
Midland, MI 48642-7035 - Phone
- (989) 832-9161
- Fax
- (989) 832-8813
- NPI assigned
- Jul 15, 2020
- Sex
- Male
- 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 | 6801092058 | MI | Primary |
Addresses
Primary practice location
1205 E Wackerly St
Midland, MI 48642-7035
Mailing address
1205 E Wackerly St
Midland, MI 48642-7035
Phone (989) 832-9161
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, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1205 E Wackerly St
Midland, MI 48642-7035
Phone (989) 832-9161
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801092058 | 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 and National Provider Directory roles.
-
- Clinical Psychologist
- Midland, MI
- NPI 1740370089
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726099200000",
"number": "1659989705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 E WACKERLY ST",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486427035",
"telephone_number": "989-832-9161",
"fax_number": "989-832-8813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1205 E WACKERLY ST",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486427035",
"telephone_number": "989-832-9161",
"fax_number": "989-832-8813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITRICK",
"first_name": "JEFFERY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-15",
"last_updated": "2024-09-12",
"certification_date": "2024-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801092058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.