Individual provider Active NPI

Michelle Wilsusen

  • Clinical Social Worker
  • Baldwin, NY
National Provider Identifier
1992032593
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
078022 Issued in NY
Practice address
2277 Grand Ave
Baldwin, NY 11510-3148
Phone
(516) 377-5400
NPI assigned
Nov 3, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 078022 NY Primary
Social Worker 104100000X 076326 NY

Addresses

Primary practice location

2277 Grand Ave
Baldwin, NY 11510-3148

Mailing address

2277 Grand Ave
Baldwin, NY 11510-3148
Phone (516) 377-5400

Other identifiers 1

IdentifierTypeStateIssuer
01764850MedicaidNY

Other names 1

  • Ms. Michelle Prizeman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20120814000227 NY Practitioner - Clinical Social Worker 8224284864 Reassigns benefits to 1 organization
Practice locations: Levittown, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
New York University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

64 Division Ave
215B
Levittown, NY 11756-2947
Phone (516) 477-0703

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nassau Guidance Counseling & Licensed Clinical Social Work Services PC Clinical CurrentSince Jun 11, 2012 Accepting new patients

Organizations & group practices 1

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": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1992032593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2277 GRAND AVE",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115103148",
            "telephone_number": "516-377-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2277 GRAND AVE",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115103148",
            "telephone_number": "516-377-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSUSEN",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-03",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "078022",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "076326",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01764850",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "PRIZEMAN",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baldwin, NY

Sources for this page

Verify at the official NPI Registry.