Individual provider Active NPI

Renee Lips-Bush, LISCW, LADC

  • Clinical Social Worker
  • Owatonna, MN
National Provider Identifier
1205289907
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
20719 Issued in MN
Practice address
610 Florence Ave
Owatonna, MN 55060-4704
Phone
(507) 451-2630
NPI assigned
Jul 18, 2016
Last updated
Feb 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 303107 MN
Clinical Social Worker 1041C0700X 20719 MN Primary

Addresses

Primary practice location

610 Florence Ave
Owatonna, MN 55060-4704

Mailing address

610 Florence Ave
Owatonna, MN 55060-4704
Phone (507) 451-2630

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address messagec@direct.schrc.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20160819000344 MN Practitioner - Clinical Social Worker 0547555237

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

610 Florence Ave
Owatonna, MN 55060-4704

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
303107MNMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1205289907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 FLORENCE AVE",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604704",
            "telephone_number": "507-451-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 FLORENCE AVE",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604704",
            "telephone_number": "507-451-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPS-BUSH",
        "first_name": "RENEE",
        "credential": "LISCW, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-18",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303107",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "20719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "messagec@direct.schrc.com",
            "affiliation": "N",
            "address_1": "610 Florence Ave",
            "city": "Owatonna",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550604704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Owatonna, MN

Sources for this page

Verify at the official NPI Registry.