Individual provider Active NPI

Jennifer Gavrila, LLMSW

  • Clinical Social Worker
  • Lincoln Park, MI
National Provider Identifier
1861860496
Registry record updated Sep 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
26184 Outer Dr
Lincoln Park, MI 48146-2084
Phone
(313) 389-7500
NPI assigned
Sep 14, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2015

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

26184 Outer Dr
Lincoln Park, MI 48146-2084

Mailing address

26184 Outer Dr
Lincoln Park, MI 48146-2084
Phone (313) 389-7500

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
I20171106001372 MI Practitioner - Clinical Social Worker 7214293398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

16836 Newburgh Rd
Suite 27
Livonia, MI 48154-1600
Phone (734) 464-4220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group CurrentSince Dec 15, 2018 Accepting new patients
University Physician Group Social Worker Past Accepting new patients

Locations

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

16836 Newburgh Rd
Ste 27
Livonia, MI 48154

16836 Newburgh Rd
#27
Livonia, MI 48154
Phone (734) 464-4220

Organizations & group practices 2

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": "1442188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442188800000",
    "number": "1861860496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26184 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-389-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26184 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462084",
            "telephone_number": "313-389-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVRILA",
        "first_name": "JENNIFER",
        "credential": "LLMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-14",
        "last_updated": "2015-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln Park, MI

Sources for this page

Verify at the official NPI Registry.