Active NPI
Sara Russell, CCC SLP
- Speech-Language Pathologist
- Worcester, MA
National Provider Identifier
1376517383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6577
- Practice address
- 135 Gold Star Blvd
Worcester, MA 01606 - Phone
- (508) 852-0600
- Fax
- (508) 853-1907
- NPI assigned
- Feb 15, 2006
- Last updated
- Feb 25, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6577 | MD | Primary |
Addresses
Primary practice location
135 Gold Star Blvd
Worcester, MA 01606
Mailing address
630 Plantation St
Worcester, MA 01605
Phone (508) 852-0600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0708925 | Medicaid | MA | |
| 042472266 | Other | TRICARE CHAMPUS | |
| 90920 | Other | FALLON COMMUNITY HEALTH P |
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 |
|---|---|---|---|
| 6577 | MD | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical Group, Inc | Past | Accepting new patients | |
| Reliant Medical Group, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Worcester, MA
- NPI 1295827962
-
- Family Medicine Physician
- Worcester, MA
- NPI 1720017528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235520000000",
"number": "1376517383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 PLANTATION ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01605",
"telephone_number": "508-852-0600",
"fax_number": "508-853-1907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 GOLD STAR BLVD",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01606",
"telephone_number": "508-852-0600",
"fax_number": "508-853-1907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "SARA",
"credential": "CCC SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2009-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "6577",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0708925",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE CHAMPUS",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH P",
"identifier": "90920",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.