Active NPI
Yvonne Shepherd
- Student in an Organized Health Care Education/Training Program
- Detroit, MI
National Provider Identifier
1699158816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 11000 W McNichols Rd
Ste 320
Detroit, MI 48221-2357 - Phone
- (313) 340-4442
- Fax
- (313) 340-4443
- NPI assigned
- Jul 7, 2015
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MI | Primary |
Addresses
Primary practice location
11000 W McNichols Rd
Ste 320
Detroit, MI 48221-2357
Mailing address
3402 Preston St
Detroit, MI 48207-2446
Phone (313) 244-7177
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1348886 | Medicaid | MI | |
| 291998 | Medicaid | MI | |
| 358813 | Medicaid | MI | |
| 24957 | Medicaid | MI |
Other names 1
- Ms. Yvonne Russell
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psygenics Inc | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- Dearborn, MI
- NPI 1669736104
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436227200000",
"number": "1699158816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3402 PRESTON ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482072446",
"telephone_number": "313-244-7177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11000 W MCNICHOLS RD",
"address_2": "STE 320",
"city": "DETROIT",
"state": "MI",
"postal_code": "482212357",
"telephone_number": "313-340-4442",
"fax_number": "313-340-4443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "YVONNE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-07",
"last_updated": "2015-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1348886",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "291998",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "358813",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "24957",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "YVONNE",
"last_name": "RUSSELL",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.