Individual provider Active NPI

Jimmie Scott Woodward, MSW

  • Social Worker
  • Monroe, MI
National Provider Identifier
1811331879
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801109218 Issued in MI
Practice address
408 E 6TH St
Monroe, MI 48161-1306
Phone
(734) 934-7957
NPI assigned
Apr 22, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6803085886 MI
Clinical Social Worker 1041C0700X 6801109218 MI
Social Worker 104100000X 6801109218 MI Primary

Addresses

Primary practice location

408 E 6TH St
Monroe, MI 48161-1306

Mailing address

408 E 6TH St
Monroe, MI 48161-1306
Phone (734) 934-7957

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
I20220721000581 MI Practitioner - Clinical Social Worker 9436530557 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801109218MIMDSocial Worker
6803085886MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Kneip, PH.D., P.C. CurrentSince Jun 24, 2022 Accepting new patients

Locations

6548 Town Center Dr
Ste D
Clarkston, MI 48346
Phone (248) 212-8739

89 W South Blvd
Ste 200
Troy, MI 48085
Phone (248) 813-8840

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1811331879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E 6TH ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611306",
            "telephone_number": "734-934-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 E 6TH ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611306",
            "telephone_number": "734-934-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODWARD",
        "first_name": "JIMMIE",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-22",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6803085886",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801109218",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801109218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.