Individual provider Active NPI

Nettie Ruth Mistic, LISW

  • Social Worker
  • Lancaster, OH
National Provider Identifier
1306819131
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
I.0001796 Issued in OH
Practice address
131 N Ewing St
Unit B
Lancaster, OH 43130-3383
Phone
(740) 689-6700
Fax
(740) 689-6702
NPI assigned
Feb 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X I.0001796 OH Primary

Addresses

Primary practice location

131 N Ewing St
Unit B
Lancaster, OH 43130-3383

Mailing address

131 N Ewing St
Unit B
Lancaster, OH 43130-3383
Phone (740) 689-6700

Other identifiers 2

IdentifierTypeStateIssuer
I 0001796OtherOHLICENSE NUMBER
000000387062OtherOHANTHEM BCBS

Other names 1

  • Nettie Ruth Sturgeon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20060302000304 OH Practitioner - Clinical Social Worker 7618983446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1979
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Avenues of Counseling and MediationGroup PAC ID 6406931880, 27 clinicians

Practice addresses (Care Compare)

230 S Court St
Suite 5
Medina, OH 44256-2259
Phone (330) 723-7977

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Avenues of Counseling and Mediation CurrentSince Jan 26, 2011 Accepting new patients
River Valley Counseling, LLC PastSince Mar 1, 2006 Accepting new patients
Lisa Borchert Dba Avenues of Counseling PastSince Jan 26, 2011 Accepting new patients

Locations

230 S Court St
Ste 5
Medina, OH 44256
Phone (330) 723-7977

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306819131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 N EWING ST",
            "address_2": "UNIT B",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431303383",
            "telephone_number": "740-689-6700",
            "fax_number": "740-689-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 N EWING ST",
            "address_2": "UNIT B",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431303383",
            "telephone_number": "740-689-6700",
            "fax_number": "740-689-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISTIC",
        "first_name": "NETTIE",
        "middle_name": "RUTH",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.0001796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "I 0001796",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000387062",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NETTIE",
            "last_name": "STURGEON",
            "middle_name": "RUTH",
            "credential": "LISW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lancaster, OH

Sources for this page

Verify at the official NPI Registry.