Renee A Johnson, LMSW
Individual provider Active NPI Clinical Social Worker · Brimley, MI
NPI 1821297318 · NPPES record last updated Jan 31, 2018
Key facts
- NPI
- 1821297318
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801086777 (MI)
- Practice address
- 12124 W Lakeshore Dr
Brimley, MI 49715-9319 - Phone
- (906) 248-5527
- Fax
- (906) 248-5765
- NPI assigned
- Jul 13, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bay Mills Indian Community
Practice addresses (Care Compare)
12455 W Lakeshore Dr
Brimley, MI 49715-9327
Phone (906) 248-5527
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040213000161 | MI | Practitioner - Clinical Social Worker | 0840184347 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801086777 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Mills Indian Community | Current |
Accepting new patients | |
| Bay Mills Indian Community | Current | Accepting new patients | |
| Bay Mills Indian Community | Current |
Accepting new patients |
Locations
12124 W Lakeshore Dr
Brimley, MI 49715
Phone (906) 248-5527
12455 W Lakeshore Dr
Brimley, MI 49715
Phone (906) 248-5527
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6801086777 | MI | |
| Clinical Social Worker | 1041C0700X | 6801086777 | MI | Yes |
Addresses
Primary practice location
12124 W Lakeshore Dr
Brimley, MI 49715-9319
Mailing address
12124 W Lakeshore Dr
Brimley, MI 49715-9319
Phone (906) 248-5527
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821297318 | Medicaid | MI |
Other providers in Brimley, MI
- Lucy Parish Dewildt
- Lynda Gregorini
- Rachel Lindsay Hileman
- Wendy K Jamros
- Miranda L Johnson
- Alicia Michelle Kasper
- Jaquelin Killips
- Anthony Joseph Langenfeld Jr.
- Sherri Larock-Macdonald
- Danielle Lynn Leblanc
All providers in Brimley, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.