NPIMap

Organization Active NPI

Flourishing Lives Inc

  • Occupational Therapist
  • Saint Clair Shores, MI
National Provider Identifier
1699377960
Registry record updated Jul 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
FLOURISHING LIVES INC
Practice address
30801 Jefferson Ave
Saint Clair Shores, MI 48082-1732
Phone
(586) 293-1234
NPI assigned
Nov 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2024

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

Authorized official

Name
Gwen Claussen
Title
Ceo
Phone
(219) 427-7839

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

30801 Jefferson Ave
Saint Clair Shores, MI 48082-1732

Mailing address

128 Brooklet Cir
Saint Marys, GA 31558-9057
Phone (219) 427-7839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210120000608 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7810300597 Receives reassigned benefits from 2 practitioners
Practice locations: Saint Clair Shores, MI

National Provider Directory

National Provider Directory

Locations

30801 Jefferson Ave
Saint Clair Shores, MI 48082
Phone (586) 293-1234

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722124800000",
    "number": "1699377960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 BROOKLET CIR",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315589057",
            "telephone_number": "219-427-7839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30801 JEFFERSON AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821732",
            "telephone_number": "586-293-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLOURISHING LIVES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-12",
        "last_updated": "2024-07-28",
        "certification_date": "2024-07-28",
        "status": "A",
        "authorized_official_last_name": "CLAUSSEN",
        "authorized_official_first_name": "GWEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-427-7839"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.