Individual provider Active NPI

Kevin Mark Flanigan, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1891544672
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801116191 Issued in MI
Practice address
669 Stocking Ave NW
Grand Rapids, MI 49504-5176
Phone
(616) 235-1480
Fax
(616) 940-5820
NPI assigned
May 15, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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 6801116191 MI Primary

Addresses

Primary practice location

669 Stocking Ave NW
Grand Rapids, MI 49504-5176

Mailing address

1861 Lockmere Dr SE
Kentwood, MI 49508-6319
Phone (248) 421-3043

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
I20240615000169 MI Practitioner - Clinical Social Worker 4385187657 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Street Services IncGroup PAC ID 6800707647, 58 clinicians

Practice addresses (Care Compare)

100 Cherry St SE
Grand Rapids, MI 49503-4526

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801116191MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cherry Street Services, Inc. Social Worker CurrentSince May 27, 2024 Accepting new patients
Cherry Street Services, Inc Clinical CurrentSince May 27, 2024 Accepting new patients

Locations

669 Stocking Ave NW
Grand Rapids, MI 49504
Phone (616) 235-1480

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

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": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1891544672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1861 LOCKMERE DR SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495086319",
            "telephone_number": "248-421-3043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "669 STOCKING AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495045176",
            "telephone_number": "616-235-1480",
            "fax_number": "616-940-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANIGAN",
        "first_name": "KEVIN",
        "middle_name": "MARK",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801116191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.