Active NPI
Peter Ross Elliott, LMSW, CAADC, CCS
- Clinical Social Worker
- Detroit, MI
National Provider Identifier
1891060869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801046721
- Practice address
- 15380 Monica St
Detroit, MI 48238-1942 - Phone
- (313) 345-3600
- Fax
- (313) 345-1586
- NPI assigned
- Mar 9, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | 6801046721 | MI | Primary |
Addresses
Primary practice location
15380 Monica St
Detroit, MI 48238-1942
Mailing address
300 Benjamin Dr
Ypsilanti, MI 48198-3094
Phone (734) 483-1718
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C-00023 | Other | MI | MICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS - CAADC |
| 6801046721 | Other | MI | DEPARTMENT OF COMMUNITY HEALTH BOARD OF SOCIAL WORK |
| C-J0012 | Other | MI | MICHIGANB CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS |
| S-00013 | Other | MI | MICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS - CCS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801046721 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331251200000",
"number": "1891060869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 BENJAMIN DR",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481983094",
"telephone_number": "734-483-1718",
"fax_number": "313-346-3600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15380 MONICA ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482381942",
"telephone_number": "313-345-3600",
"fax_number": "313-345-1586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "PETER",
"middle_name": "ROSS",
"name_prefix": "Mr.",
"credential": "LMSW, CAADC, CCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-09",
"last_updated": "2012-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801046721",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS - CAADC",
"identifier": "C-00023",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF COMMUNITY HEALTH BOARD OF SOCIAL WORK",
"identifier": "6801046721",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGANB CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS",
"identifier": "C-J0012",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS - CCS",
"identifier": "S-00013",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.