Unknown Individual – Clinical Social Worker, NPI 1700139904

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Petoskey, Michigan. specializing in Clinical Social Worker. They hold a License No. 6801089396 (MI). The NPI Number for Unknown Individual is 1700139904

Main info

Organization

Inactive

19 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1700139904

Phone

(231) 487-2415

Address

2206 MITCHELL PARK DR

Deactivation Date

5 June 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2314876076

Graduation Year

2007 (19 years ago)

PAC ID

1850537648

Group Practice PAC ID

5890931679

Professional Enrollment ID

I20130424000278

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

2206 MITCHELL PARK DR
SUITE 10
PETOSKEY, MI 497708674
Phone: (231) 487-2415
Mailing address matches the actual address.

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 49770)

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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: 5890931679View full group profile

Name	Specialty	State
MRS. GERALDINE DORRIS (A.R.N.P.)	-	FL
MR. ANTHONY DAVID DILORETO (PMHNP, RN)	-	MI

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?

Administrative and clinical systems typically use NPI 1700139904 for Unknown Individual.

What should I verify if Unknown Individual is listed inactive?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Clinical Social Worker. Clinical services aligned with this taxonomy classification.

What city is tied to Unknown Individual?

The directory associates Unknown Individual with Petoskey, Michigan. Check all listed addresses for suites or satellite offices.

What is the difference between NPI and a medical license?

An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.