Active NPI
Russell John Simon I, LPCC-S
- Professional Counselor
- Grove City, OH
National Provider Identifier
1710493366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.1800623-SUPV
- Practice address
- 5665 Hoover Rd
Grove City, OH 43123-9122 - Phone
- (614) 539-6545
- NPI assigned
- Dec 19, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | C.1400157 | OH | |
| Professional Counselor | 101YP2500X | E.1800623-SUPV | OH | Primary |
Addresses
Primary practice location
5665 Hoover Rd
Grove City, OH 43123-9122
Mailing address
3560 Woodland Dr
Hilliard, OH 43026-2627
Phone (614) 593-0446
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1335 Dublin Rd
Suite 212C
Columbus, OH 43215-7045
Phone (614) 437-9910
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C.1400157 | OH | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Live Wellness Center, LTD. | Professional | Current | Accepting new patients |
Locations
1335 Dublin Rd
Ste 212C
Columbus, OH 43215
Phone (614) 437-9910
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561420800000",
"number": "1710493366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3560 WOODLAND DR",
"city": "HILLIARD",
"state": "OH",
"postal_code": "430262627",
"telephone_number": "614-593-0446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5665 HOOVER RD",
"city": "GROVE CITY",
"state": "OH",
"postal_code": "431239122",
"telephone_number": "614-539-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "RUSSELL",
"middle_name": "JOHN",
"name_suffix": "I",
"credential": "LPCC-S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-19",
"last_updated": "2019-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OH",
"license": "C.1400157",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.1800623-SUPV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grove City, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.