Individual provider Active NPI

Cherie Donnette Rucker, LLMSW

  • Social Worker
  • Grand Rapids, MI
National Provider Identifier
1760776801
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801089464 Issued in MI
Practice address
1333 Alger St SE Ste 6
Grand Rapids, MI 49507-3809
Phone
(616) 777-7399
Fax
(616) 773-1383
NPI assigned
Jun 7, 2011
Last updated
Apr 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801089464 MI Primary

Addresses

Primary practice location

1333 Alger St SE Ste 6
Grand Rapids, MI 49507-3809

Mailing address

1333 Alger St SE Ste 6
Grand Rapids, MI 49507-3809
Phone (616) 777-7399

Other identifiers 1

IdentifierTypeStateIssuer
211715928MedicaidMI

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
I20170324000499 MI Practitioner - Clinical Social Worker 2860777356 Practice locations: Grand Rapids, MI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1333 Alger St SE
Suite 6
Grand Rapids, MI 49507-3809
Phone (616) 777-7399

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801089464MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Counseling Ctr CurrentSince Aug 2, 2020 Accepting new patients

Locations

2021 44th St SE
Ste C
Grand Rapids, MI 49508
Phone (616) 777-7399

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1760776801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 ALGER ST SE STE 6",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495073809",
            "telephone_number": "616-777-7399",
            "fax_number": "616-773-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 ALGER ST SE STE 6",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495073809",
            "telephone_number": "616-777-7399",
            "fax_number": "616-773-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKER",
        "first_name": "CHERIE",
        "middle_name": "DONNETTE",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-07",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801089464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211715928",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.