Paula Kathleen Wietrzykowski, L.M.S.W.

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801081581 Issued in MI

Practice address

6050 N US Highway 31
Free Soil, MI 49411-9157

Phone

(231) 757-1260

Fax

(231) 757-1261

NPI assigned

May 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Clinical Social Worker

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lighthouse Associates LLCGroup PAC ID 0547403867, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lighthouse Associates LLC

  • Clinical Social Worker
  • Ludington, MI
  • NPI 1053759589
  Medicare reassignment Care Compare group NPD
• Harbor Front Family Chiropractors LLC

  • Chiropractor
  • Ludington, MI
  • NPI 1689810004
  NPD (past)
• Lighthouse Professional Clinic, P.C.

  • Psychiatry Physician
  • Ludington, MI
  • NPI 1407902109
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204588800000",
    "number": "1912959479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 N US HIGHWAY 31",
            "city": "FREE SOIL",
            "state": "MI",
            "postal_code": "494119157",
            "telephone_number": "231-757-1260",
            "fax_number": "231-757-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 N US HIGHWAY 31",
            "city": "FREE SOIL",
            "state": "MI",
            "postal_code": "494119157",
            "telephone_number": "231-757-1260",
            "fax_number": "231-757-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETRZYKOWSKI",
        "first_name": "PAULA",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "L.M.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801081581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0897371",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "383322171",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelyn Graczyk
• Susan K Henry, MD
• Richard Lee Mogerman, MD
• Amanda Nasor
• West Mi. Regional Cancer and Blood Center

• Social Worker in Free Soil, MI
• Providers in Free Soil, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.