Kimberly C Hazel, LMSW, ACSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801-065462 Issued in MI

Practice address

1 N Starkweather Aly FL 3
Romeo, MI 48065

Phone

(586) 281-6815

Fax

(586) 281-6816

NPI assigned

Sep 28, 2006

Sex

Female

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

Wayne State University School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shine Wellness Clinic PLLCGroup PAC ID 3476825043, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Shine Wellness Clinic, PLLC

  • Social Worker
  • Romeo, MI
  • NPI 1952822587

  MI

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1801987136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N STARKWEATHER ALY FL 3",
            "city": "ROMEO",
            "state": "MI",
            "postal_code": "480654690",
            "telephone_number": "586-281-6815",
            "fax_number": "586-281-6816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 N STARKWEATHER ALY FL 3",
            "city": "ROMEO",
            "state": "MI",
            "postal_code": "48065",
            "telephone_number": "586-281-6815",
            "fax_number": "586-281-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZEL",
        "first_name": "KIMBERLY",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "LMSW, ACSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801-065462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Everly, OTRL
• Donald W Felstow, PT
• Harry Gee, M.D.
• Amrit Gill
• Mark Edgar Hardwick, D.D.S.
• Robert Everett Henderson IV
• Robert Samuel Herman, DDS
• Kathryn Marie Hill, L.L.P.
• Dawn April Howey, MA LPC
• Dawn Marie Hubbard, RN

• All providers in Romeo, MI
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.