Jacqueline Russell

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-11118 Issued in NM

Practice address

1301 Oregon Ave
Alamogordo, NM 88310-5710

Phone

(575) 443-6166

Fax

(575) 437-0755

NPI assigned

Nov 17, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jacqueline R Mason Former name

Medicare fee-for-service enrollment

Enrolled in NM

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Smart Perspectives LLC

  • Professional Counselor
  • Alamogordo, NM
  • NPI 1659063600
  Medicare reassignment NPD
• Carlsbad Lifehouse Inc

  • Community/Behavioral Health Agency
  • Carlsbad, NM
  • NPI 1588521579
  Medicare reassignment
• Carlsbad Lifehouse Inc

  • Community/Behavioral Health Agency
  • Carlsbad, NM
  • NPI 1992398457
  Medicare reassignment

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1194267419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 553",
            "city": "HI RLS MTN PK",
            "state": "NM",
            "postal_code": "883250553",
            "telephone_number": "575-443-6166",
            "fax_number": "575-437-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 OREGON AVE",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883105710",
            "telephone_number": "575-443-6166",
            "fax_number": "575-437-0755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 Cuba Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Alamogordo",
            "state": "NM",
            "postal_code": "883105646",
            "country_code": "US",
            "telephone_number": "575-404-1593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-17",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S1601116",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-11118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "MASON",
            "middle_name": "R",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alejandra Ruiz
• Venisa Ruiz
• Joseph Rummel
• Terri Rummel
• Alysa Ruocco
• Laura Russell, BMS
• Nicholas Aaron Russell, LPCC
• Richard Rutledge Russell, PH.D.
• Rustic Health LLC
• Rustic Health Primary Care LLC

• Clinical Social Worker in Alamogordo, NM
• Providers in Alamogordo, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.