Individual provider Active NPI

Michael Gene Gipson, LCSW

  • Clinical Social Worker
  • Jonesboro, AR
National Provider Identifier
1821024704
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
4508 Stadium Blvd
Jonesboro, AR 72404-9675
Phone
(870) 933-6886
Fax
(870) 933-9395
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

4508 Stadium Blvd
Jonesboro, AR 72404-9675

Mailing address

4508 Stadium Blvd
Jonesboro, AR 72404-9675
Phone (870) 933-6886

Other identifiers 1

IdentifierTypeStateIssuer
5W419OtherARBLUE CROSS NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20070724000302 FL Practitioner - Clinical Social Worker 2668498353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Theracounsel, Inc.Group PAC ID 0143206466, 17 clinicians

Practice addresses (Care Compare)

4546 N Federal Hwy
Fort Lauderdale, FL 33308-5204
Phone (954) 716-6514

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Theracounsel, Inc. Clinical CurrentSince Apr 5, 2018 Accepting new patients

Locations

4546 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 328-6163

2040 N Dixie Hwy
Ste 229
Wilton Manors, FL 33305
Phone (954) 478-0770

Networks

  • Freedom Health HMO Network

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821024704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4508 STADIUM BLVD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724049675",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4508 STADIUM BLVD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724049675",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIPSON",
        "first_name": "MICHAEL",
        "middle_name": "GENE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "5W419",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.