Unknown Individual – Clinical Social Worker, NPI 1780004911

Unknown Individual is a healthcare provider. based in Grand rapids, Michigan. specializing in Clinical Social Worker. They hold a License No. 6801097365 (MI). The NPI Number for Unknown Individual is 1780004911

Main info

Organization
Inactive
12 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780004911
Phone
(616) 965-8259
Address
100 CHERRY ST
Deactivation Date
27 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6164544777
Graduation Year
2014 (12 years ago)
PAC ID
4486942786
Group Practice PAC ID
9537251756
Professional Enrollment ID
I20161019000204
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 100 CHERRY ST

    GRAND RAPIDS, MI 495023598

    Phone: (616) 965-8259

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 49502)

Loading plans...

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: 9537251756View full group profile

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I cross-check Unknown Individual using NPI 1780004911?
NPI 1780004911 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Grand Rapids?
Unknown Individual currently maps to Grand Rapids, Michigan in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

Similar Providers

LISA J. GRIFFIN (LMSW)

Clinical Social Worker
61, Commerce Avenue Southwest, Grand Rapids, Kent County, Michigan, 49503, United States
NPI: 1598765992

MS. KAREN LOUISE PRICE (MSW)

Clinical Social Worker
1616, Millbrook Street Southeast, Third Ward, Grand Rapids, Kent County, Michigan, 49508, United States
NPI: 1497757892

MATTHEW D JACHALKE (LMSW)

Clinical Social Worker
Pine Rest Christian Mental Health Services, 300, 68th Street Southeast, Gaines Charter Township, Grand Rapids, Kent County, Michigan, 49501, United States
NPI: 1306833439

MS. KATHEEN DELP HIGGINS (LMSW, CGC)

Genetic Counselor (M.S.)
6613 GLENEAGLES DR SE
NPI: 1700877511

ROBERT W JR. KOPFENSTEINER (LMSW)

Clinical Social Worker
PO BOX 30516
NPI: 1386623643

Unknown Individual

Clinical Social Worker
PO BOX 30516 DEPT 6000A
NPI: 1356311393

CAROLE CHISHOLM (LMSW CSW)

Clinical Social Worker
PO BOX 30516
NPI: 1356312474

ROBERT DAVIS (LMSW CSW)

Clinical Social Worker
3330, Claystone Street Southeast, Third Ward, Grand Rapids, Kent County, Michigan, 49546, United States
NPI: 1962473090

SUSAN K STAUFFER (LMSW)

Clinical Social Worker
Leonard Street Northwest, Grand Rapids, Kent County, Michigan, 49534, United States
NPI: 1922070143