NPIMap

Organization Active NPI

D.a. Blodgett - St. John's

  • Community/Behavioral Health Agency
  • Grand Rapids, MI
National Provider Identifier
1861701229
Registry record updated Oct 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
6801088412 Issued in MI
Legal business name
D.A. BLODGETT - ST. JOHN'S
Practice address
805 Leonard St NE
Grand Rapids, MI 49503-1138
Phone
(616) 451-2021
NPI assigned
Oct 4, 2010
Last updated
Oct 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2010

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

Authorized official

Name
Mr. Benjamin Jon Brower, MSW, LMSWNPI 1841558053
Title
KSSN Site Team Clinician
Phone
(616) 826-6063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 6801088412 MI Primary

Addresses

Primary practice location

805 Leonard St NE
Grand Rapids, MI 49503-1138

Mailing address

805 Leonard St NE
Grand Rapids, MI 49503-1138

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286150400000",
    "number": "1861701229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 LEONARD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 LEONARD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031138",
            "telephone_number": "616-451-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D.A. BLODGETT - ST. JOHN'S",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-04",
        "last_updated": "2010-10-04",
        "status": "A",
        "authorized_official_last_name": "BROWER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "KSSN SITE TEAM CLINICIAN",
        "authorized_official_telephone_number": "616-826-6063",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6801088412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.