Sue Ann Russell, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

241 Issued in ND

Practice address

2704 Belmont Rd
Grand Forks, ND 58201-7538

Phone

(701) 746-8737

Fax

(701) 746-4763

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Sue a Russell PHD PC

  • Clinical Psychologist
  • Grand Forks, ND
  • NPI 1942371067
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1043382773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 BELMONT RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017538",
            "telephone_number": "701-746-8737",
            "fax_number": "701-746-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 BELMONT RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017538",
            "telephone_number": "701-746-8737",
            "fax_number": "701-746-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SUE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17418",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Rumple, SLP
• Run Your Life LLC
• Ann Russell, LAMFT
• Matthew David Russell, ABA
• Rachel N Russell, CRDH
• Tiffany D Russell
• Kathryn Gail Rustebakke, PT
• Heather Lea Rusten, DO
• Daniel Richard Rustvang, FNP-C
• Pamela A Rustvang, NP

• Clinical Psychologist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Clinical Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.