Active NPI
Ronda Russell
- Clinical Social Worker
- Dunkirk, NY
National Provider Identifier
1639488265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 074150
- Practice address
- 186 Lake Shore Dr W
Dunkirk, NY 14048-1437 - Phone
- (716) 366-6858
- NPI assigned
- Sep 30, 2010
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 074150 | NY | Primary |
Addresses
Primary practice location
186 Lake Shore Dr W
Dunkirk, NY 14048-1437
Mailing address
186 Lake Shore Dr W
Dunkirk, NY 14048-1437
Phone (716) 366-6858
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110406000057 | NY | Practitioner - Clinical Social Worker | 4385828979 | Practice locations: Jamestown, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 074150 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285804800000",
"number": "1639488265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "186 LAKE SHORE DR W",
"city": "DUNKIRK",
"state": "NY",
"postal_code": "140481437",
"telephone_number": "716-366-6858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 LAKE SHORE DR W",
"city": "DUNKIRK",
"state": "NY",
"postal_code": "140481437",
"telephone_number": "716-366-6858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "RONDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-30",
"last_updated": "2010-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "074150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dunkirk, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.