Active NPI
Bryon L Ross, LCSW
- Clinical Social Worker
- Avon, IN
National Provider Identifier
1093789992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34002964A
- Practice address
- 6655 E US Highway 36
Avon, IN 46123-8923 - Phone
- (317) 272-3330
- Fax
- (317) 272-0807
- NPI assigned
- Feb 15, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34002964A | IN | Primary |
Addresses
Primary practice location
6655 E US Highway 36
Avon, IN 46123-8923
Mailing address
250 N Shadeland Ave Ste 200
Indianapolis, IN 46219-4959
Phone (317) 962-3834
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000489634 | Other | IN | ANTHEM BCBS PROVIDER PIN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34002964A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583884800000",
"number": "1093789992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE STE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959",
"telephone_number": "317-962-3834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6655 E US HIGHWAY 36",
"city": "AVON",
"state": "IN",
"postal_code": "461238923",
"telephone_number": "317-272-3330",
"fax_number": "317-272-0807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "BRYON",
"middle_name": "L",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-15",
"last_updated": "2020-03-11",
"certification_date": "2020-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34002964A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS PROVIDER PIN",
"identifier": "000000489634",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Avon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.