Active NPI
Kelly Passalacqua, MSW, LMSW, ACSW
- Clinical Social Worker
- Bay City, MI
National Provider Identifier
1851499974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801078510
- Practice address
- 114 Tuscola
Bay City, MI 48708-6995 - Phone
- (989) 895-0788
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801078510 | MI | Primary |
Addresses
Primary practice location
114 Tuscola
Bay City, MI 48708-6995
Mailing address
114 Tuscola
Bay City, MI 48708-6995
Phone (989) 895-0788
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 042659 | Other | MI | CIGNA |
| 0995532 | Other | MI | HEALTHPLUS |
| 1014496 | Other | MI | MCLAREN |
| 042659 | Other | MI | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 13, 2015 through Jul 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801078510 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851499974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 TUSCOLA",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487086995",
"telephone_number": "989-895-0788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 TUSCOLA",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487086995",
"telephone_number": "989-895-0788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSALACQUA",
"first_name": "KELLY",
"credential": "MSW, LMSW, ACSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801078510",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "042659",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPLUS",
"identifier": "0995532",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN",
"identifier": "1014496",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "042659",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bay City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.