Active NPI
Michael Russ, LCSW
- Clinical Social Worker
- Marion, IN
National Provider Identifier
1306376124
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Oct 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34009434A
- Practice address
- 101 S Washington St
Marion, IN 46952-3867 - Phone
- (765) 662-9971
- NPI assigned
- Jun 14, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34009434A | IN | Primary |
| Social Worker | 104100000X |
Addresses
Primary practice location
101 S Washington St
Marion, IN 46952-3867
Mailing address
101 S Washington St
Marion, IN 46952-3867
Phone (765) 662-9971
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34009434A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1306376124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 S WASHINGTON ST",
"city": "MARION",
"state": "IN",
"postal_code": "469523867",
"telephone_number": "765-662-9971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S WASHINGTON ST",
"city": "MARION",
"state": "IN",
"postal_code": "469523867",
"telephone_number": "765-662-9971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSS",
"first_name": "MICHAEL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-14",
"last_updated": "2022-07-21",
"certification_date": "2021-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34009434A",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.