Active NPI
Allen Floyd Russell
- Adult Development & Aging Psychologist
- Grand Rapids, MI
National Provider Identifier
1033826136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Development & Aging Psychologist
- Practice address
- 4488 Breton Rd SE
Grand Rapids, MI 49508-5270 - Phone
- (616) 340-9026
- NPI assigned
- Oct 31, 2022
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | |||
| Adult Development & Aging Psychologist | 103TA0700X | Primary | ||
| Meals Provider | 174200000X | |||
| Physical Therapist | 225100000X | |||
| Alzheimer Center (Dementia Center) | 311500000X |
Addresses
Primary practice location
4488 Breton Rd SE
Grand Rapids, MI 49508-5270
Mailing address
2529 Bridgeport LN SE
Kentwood, MI 49508-8431
Phone (616) 340-9026
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tiffany Evans | Current | Accepting new patients | |
| Abilitiies of Western Michigan | Meals | Current | Accepting new patients |
Locations
4488 Breton Rd SE
Kentwood, MI 49508
Phone (616) 340-9026
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Kentwood, MI
- NPI 1841987484
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1033826136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2529 BRIDGEPORT LN SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495088431",
"telephone_number": "616-340-9026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4488 BRETON RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495085270",
"telephone_number": "616-340-9026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ALLEN",
"middle_name": "FLOYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-31",
"last_updated": "2022-10-31",
"certification_date": "2022-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": null,
"license": null,
"primary": true
},
{
"code": "174200000X",
"taxonomy_group": "",
"desc": "Meals",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "311500000X",
"taxonomy_group": "",
"desc": "Alzheimer Center (Dementia Center)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.