Active NPI
Jennifer Russell
- Clinical Social Worker
- Rochester, NY
National Provider Identifier
1659664217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R047014-1
- Practice address
- 85 Shell Edge Dr
Rochester, NY 14623-4356 - Phone
- (585) 359-5400
- NPI assigned
- May 16, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R047014-1 | NY | Primary |
| School Social Worker | 1041S0200X |
Addresses
Primary practice location
85 Shell Edge Dr
Rochester, NY 14623-4356
Mailing address
85 Shell Edge Dr
Rochester, NY 14623-4356
Phone (585) 359-5400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 166002034 | Medicaid | NY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R047014-1 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rush Henrietta Central School District | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Rochester, NY
- NPI 1710279443
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305676800000",
"number": "1659664217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 SHELL EDGE DR",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146234356",
"telephone_number": "585-359-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 SHELL EDGE DR",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146234356",
"telephone_number": "585-359-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-16",
"last_updated": "2011-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R047014-1",
"primary": true
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "166002034",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.