Active NPI
Eboney Russell
- Nurse's Aide
- Akron, OH
National Provider Identifier
1013441781
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Sep 20, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 400863800209
- Practice address
- 118 Robinwood Blvd
Akron, OH 44312-1325 - Phone
- (330) 777-9020
- NPI assigned
- Apr 19, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 400863800209 | OH | Primary |
Addresses
Primary practice location
118 Robinwood Blvd
Akron, OH 44312-1325
Mailing address
118 Robinwood Blvd
Akron, OH 44312-1325
Phone (330) 777-9020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0164817 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 400863800209 | OH | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492560000000",
"number": "1013441781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 ROBINWOOD BLVD",
"city": "AKRON",
"state": "OH",
"postal_code": "443121325",
"telephone_number": "330-777-9020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 ROBINWOOD BLVD",
"city": "AKRON",
"state": "OH",
"postal_code": "443121325",
"telephone_number": "330-777-9020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "EBONEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-19",
"last_updated": "2017-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "OH",
"license": "400863800209",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0164817",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Akron, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.