Individual provider Active NPI

Mercedes Noble, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1902258718
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801108559 Issued in MI
Practice address
2172 Dean Lake Ave NE
Grand Rapids, MI 49505-4444
Phone
(616) 451-2021
NPI assigned
Jul 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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 6801108559 MI Primary

Addresses

Primary practice location

2172 Dean Lake Ave NE
Grand Rapids, MI 49505-4444

Mailing address

2172 Dean Lake Ave NE
Grand Rapids, MI 49505-4444

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
I20251016002741 MI Practitioner - Clinical Social Worker 5799272373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801108559MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kent County CMH Authority CurrentSince Sep 1, 2025 Accepting new patients
Kent County CMH Authority CurrentSince Sep 1, 2025 Accepting new patients
D a Blodgett-St Johns Clinical CurrentSince Oct 10, 2015 Accepting new patients
D.a. Blodgett - St. John'S Past Accepting new patients
Kent County CMH Authority Past Accepting new patients

Locations

2172 Dean Lake Ave NE
Grand Rapids, MI 49505
Phone (616) 451-2021

790 Fuller Ave NE
Grand Rapids, MI 49503
Phone (616) 336-3765

805 Leonard St NE
Grand Rapids, MI 49503
Phone (616) 451-2021

Organizations & group practices 5

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": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1902258718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2172 DEAN LAKE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2172 DEAN LAKE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054444",
            "telephone_number": "616-451-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBLE",
        "first_name": "MERCEDES",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-05",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801108559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.