Individual provider Active NPI

Rebecca Joy Russo Johnson, LISW

  • Clinical Social Worker
  • Dayton, OH
National Provider Identifier
1366816704
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I. 1501275 Issued in OH
Practice address
2261 Philadelphia Drive
Dayton, OH 45406
Phone
(937) 734-6763
NPI assigned
Nov 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I. 1501275 OH Primary

Addresses

Primary practice location

2261 Philadelphia Drive
Dayton, OH 45406

Mailing address

2375 Bugleboy CT
Miamisburg, OH 45342-4492
Phone (937) 321-6192

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
I20190819001188 OH Practitioner - Clinical Social Worker 1456689207 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I. 1501275OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Five Rivers Health Centers Current Accepting new patients
Five Rivers Health Centers CurrentSince Jul 13, 2019 Accepting new patients

Locations

2261 Philadelphia Dr
Dayton, OH 45406
Phone (937) 281-6800

721 Miami Chapel Rd
Dayton, OH 45417
Phone (937) 281-5970

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": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1366816704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 BUGLEBOY CT",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453424492",
            "telephone_number": "937-321-6192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2261 PHILADELPHIA DRIVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45406",
            "telephone_number": "937-734-6763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "REBECCA",
        "middle_name": "JOY RUSSO",
        "name_prefix": "Mrs.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-23",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I. 1501275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.