Individual provider Active NPI

Susan Kirt, LMSW

  • Clinical Social Worker
  • Traverse City, MI
National Provider Identifier
1962826982
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L2549405 Issued in MI
Practice address
1050 Silver Dr
Traverse City, MI 49684-5749
Phone
(231) 947-2255
Fax
(231) 947-5982
NPI assigned
Feb 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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 L2549405 MI Primary

Addresses

Primary practice location

1050 Silver Dr
Traverse City, MI 49684-5749

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 281-6372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • 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
I20170221000430 MI Practitioner - Clinical Social Worker 9335423235 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L2549405MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Jan 18, 2017 Accepting new patients
Mindful Life Practice, LLC Clinical CurrentSince Jan 1, 2025 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jan 18, 2017 Accepting new patients

Locations

221 Garland St
Traverse City, MI 49684
Phone (231) 486-0805

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 3

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": "1392076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484265600000",
    "number": "1962826982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-281-6372",
            "fax_number": "616-281-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 SILVER DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845749",
            "telephone_number": "231-947-2255",
            "fax_number": "231-947-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRT",
        "first_name": "SUSAN",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-11",
        "last_updated": "2017-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "L2549405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.