Individual provider Active NPI

Shannon Leigh Porter

  • Clinical Social Worker
  • Saint Clair, MI
National Provider Identifier
1669365078
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801078877 Issued in MI
Practice address
1322 River Rd
Saint Clair, MI 48079-2803
Phone
(269) 420-4959
NPI assigned
Jun 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801078877 MI Primary

Addresses

Primary practice location

1322 River Rd
Saint Clair, MI 48079-2803

Mailing address

812 Brown St
Saint Clair, MI 48079-4893
Phone (269) 420-4959

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250618001494 MI Practitioner - Clinical Social Worker 7416468293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Norserv Group LTDGroup PAC ID 3577460047, 8 clinicians

Practice addresses (Care Compare)

1322 River Rd
Saint Clair, MI 48079-2803
Phone (810) 329-4798

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801078877MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Norserv Group LTD CurrentSince Jun 11, 2025 Accepting new patients
St Clair County Community Mental Health Authority PastSince Jun 8, 2025 Accepting new patients

Locations

1322 River Rd
Saint Clair, MI 48079
Phone (810) 329-4798

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1669365078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 BROWN ST",
            "city": "SAINT CLAIR",
            "state": "MI",
            "postal_code": "480794893",
            "telephone_number": "269-420-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 RIVER RD",
            "city": "SAINT CLAIR",
            "state": "MI",
            "postal_code": "480792803",
            "telephone_number": "269-420-4959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "SHANNON",
        "middle_name": "LEIGH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-03",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801078877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair, MI

Sources for this page

Verify at the official NPI Registry.