Unknown Individual – Clinical Social Worker, NPI 1124455100

Unknown Individual is a healthcare provider. based in Kalamazoo, Michigan. specializing in Clinical Social Worker. They hold a License No. 6801093440 (MI). The NPI Number for Unknown Individual is 1124455100

Main info

Organization
Inactive
15 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124455100
Phone
Not provided
Address
1428 HOMECREST AVE
Deactivation Date
27 September 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5865731810
Graduation Year
2011 (15 years ago)
PAC ID
8224349402
Group Practice PAC ID
5698906907
Professional Enrollment ID
I20150615000509
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 1428 HOMECREST AVE

    KALAMAZOO, MI 490014325

    Phone:

    Type: Mailing

  • 1400 GULL RD

    KALAMAZOO, MI 490481605

    Phone: (269) 385-8533

    Fax: (269) 385-6064

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 49001)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5698906907View full group profile
NameSpecialtyState
Clinical Social WorkerMI
Clinical Social WorkerGA
Nurse PractitionerMI
Clinical Social WorkerMI
Clinical Social WorkerMI
Mental Health CounselorMI
Nurse PractitionerMI
-MI
-MI
P S Y C H I A T R YOH

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1124455100 if you need a stable reference for Unknown Individual.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Kalamazoo, Michigan for Unknown Individual; expand the address list for detail.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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