Zachary Paul Wollack, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801092307 Issued in MI

Practice address

43902 Woodward Ave Ste 100
Bloomfield Hills, MI 48302-5021

Phone

(248) 724-2643

Fax

(248) 516-0068

NPI assigned

Nov 7, 2017

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

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

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wolverine Human ServicesGroup PAC ID 4385928597, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Wolverine Human Services

  • Clinical Social Worker
  • Taylor, MI
  • NPI 1720434426

  Clinical, MI

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1710490271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43902 WOODWARD AVE STE 100",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025021",
            "telephone_number": "888-622-3345",
            "fax_number": "248-516-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43902 WOODWARD AVE STE 100",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025021",
            "telephone_number": "248-724-2643",
            "fax_number": "248-516-0068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20300 Superior Rd Ste 160",
            "address_purpose": "LOCATION",
            "city": "Taylor",
            "state": "MI",
            "postal_code": "481806341",
            "country_code": "US",
            "telephone_number": "888-622-3345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLLACK",
        "first_name": "ZACHARY",
        "middle_name": "PAUL",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801092307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Beth Wilson de Medina, M.S.,L.L.P.
• Kate Wilson
• Marc I Wittenberg, MD
• Ashley L Wohlfeil Laursen
• Jennifer Wolfgang, LMSW
• Joshua Wolsefer
• James Henry Wood, NP-C
• Woodward Detroit CVS LLC
• Woodward Detroit CVS, L.L.C.
• Woodward Detroit CVS, L.L.C.

• All providers in Bloomfield Hills, MI
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.