Individual provider Active NPI

Michael Ohonbamu, LMSW

  • Clinical Social Worker
  • Ann Arbor, MI
National Provider Identifier
1962061846
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801115733 Issued in MI
Practice address
110 N 4TH Ave
Ann Arbor, MI 48104-5503
Phone
(734) 544-3050
Fax
(734) 544-6732
NPI assigned
Jun 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 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 6801115733 MI Primary

Addresses

Primary practice location

110 N 4TH Ave
Ann Arbor, MI 48104-5503

Mailing address

555 Towner St
Ypsilanti, MI 48198-5723
Phone (734) 544-3050

Other identifiers 1

IdentifierTypeStateIssuer
1962061846MedicaidMI

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

LicenseStateTypeSpecialty
6801115733MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Washtenaw CurrentSince Sep 6, 2020 Accepting new patients
County of Washtenaw PastSince Sep 6, 2020 Accepting new patients

Locations

110 N 4th Ave
Ann Arbor, MI 48104
Phone (734) 222-3750

555 Towner St
Ypsilanti, MI 48198
Phone (734) 544-3000

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": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1962061846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 TOWNER ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481985723",
            "telephone_number": "734-544-3050",
            "fax_number": "734-544-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N 4TH AVE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045503",
            "telephone_number": "734-544-3050",
            "fax_number": "734-544-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OHONBAMU",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801115733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962061846",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.