Individual provider Active NPI

Robert E Radaz Jr., LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1881846830
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801064645 Issued in MI
Practice address
3292 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 365-8920
NPI assigned
Oct 21, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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 6801064645 MI Primary

Addresses

Primary practice location

3292 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

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
I20230828000964 MI Practitioner - Clinical Social Worker 9032572854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3292 N Evergreen Dr NE
Brains a Service of Pine Rest
Grand Rapids, MI 49525-9746
Phone (616) 365-8920

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Oct 27, 2025 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Oct 27, 2025 Accepting new patients

Locations

3292 N Evergreen Dr NE
#A
Grand Rapids, MI 49525
Phone (616) 365-8920

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

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": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1881846830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3292 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-365-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADAZ",
        "first_name": "ROBERT",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-21",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801064645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.