Active NPI
Roderick W Bruce, LCSW
- Clinical Social Worker
- Fishers, IN
National Provider Identifier
1316242167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34004707A
- Practice address
- 10765 Lantern Rd
Ste 102
Fishers, IN 46038-3596 - Phone
- (317) 621-4181
- Fax
- (317) 621-4182
- NPI assigned
- Jan 25, 2011
- 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 | 34004707A | IN | Primary |
Addresses
Primary practice location
10765 Lantern Rd
Ste 102
Fishers, IN 46038-3596
Mailing address
10765 Lantern Rd
Ste 102
Fishers, IN 46038-3596
Phone (317) 621-4181
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9709665 | Other | IN | AETNA |
| 000000701068 | Other | IN | ANTHEM |
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 |
|---|---|---|---|
| 34004707A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315440000000",
"number": "1316242167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10765 LANTERN RD",
"address_2": "STE 102",
"city": "FISHERS",
"state": "IN",
"postal_code": "460383596",
"telephone_number": "317-621-4181",
"fax_number": "317-621-4182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10765 LANTERN RD",
"address_2": "STE 102",
"city": "FISHERS",
"state": "IN",
"postal_code": "460383596",
"telephone_number": "317-621-4181",
"fax_number": "317-621-4182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCE",
"first_name": "RODERICK",
"middle_name": "W",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-01-25",
"last_updated": "2011-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34004707A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "9709665",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000701068",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fishers, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.