SHAVONNE ANNETTE BRUBAKER, LMSW — NPI 1124228655 (Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical in MT PLEASANT, MI)

CMS-1500 Box 24J / 33a • NPI

1124228655

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1041C0700X (CMS 80)

Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical

Box 32 Service Location & ZIP+4

301 S CRAPO ST, SUITE 200, MT PLEASANT, MI, 48858-2941

✓ 9-Digit EDI 837 ZIP+4 (48858-2941)

Practice Phone & Referral Fax

(989) 772-5938

Fax: (989) 775-7701

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1124228655 (SHAVONNE ANNETTE BRUBAKER, LMSW) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1124228655` (NPI-1 Individual Practitioner)
Provider / Legal Name	SHAVONNE ANNETTE BRUBAKER, LMSW
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: `1041C0700X` (Social Worker, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	301 S CRAPO ST, SUITE 200, MT PLEASANT, MI, 48858-2941
Practice Telephone / Fax	Tel: (989) 772-5938 \| Fax: (989) 775-7701
Administrative Mailing Address	655 E CEDAR AVE, GLADWIN, MI, 48624-2215
Enumeration & Last Sync	Enumerated: 2007-07-23 \| CMS Record Updated: 2013-04-01

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

301 S CRAPO ST, SUITE 200, MT PLEASANT, MI, 48858-2941

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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)

What Does Taxonomy Code 1041C0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 80 (Licensed Clinical Social Worker)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SHAVONNE ANNETTE BRUBAKER, LMSW)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: MI \| License: `6801089331` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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SHAVONNE ANNETTE BRUBAKER, LMSW (NPI #1124228655)