Individual provider Active NPI

Michael Rouse

  • Case Manager/Care Coordinator
  • The Plains, OH
National Provider Identifier
1730646712
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
49 Johnson Rd
The Plains, OH 45780-1146
Phone
(740) 764-4529
NPI assigned
Feb 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Addiction (Substance Use Disorder) Counselor 101YA0400X APP-000218442 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X 170009 OH
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

49 Johnson Rd
The Plains, OH 45780-1146

Mailing address

9 Chesapeake PLZ
Chesapeake, OH 45619-1003
Phone (740) 764-4529

Other identifiers 1

IdentifierTypeStateIssuer
1730646712MedicaidOH

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

LicenseStateTypeSpecialty
170009OHMDAddiction (Substance Use Disorder) Counselor
APP-000218442OHMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Group Home, LLC CurrentSince Apr 28, 2024 Accepting new patients
Phoenix Group Home, LLC PastSince Apr 28, 2024 Accepting new patients

Locations

306 W Union St
Athens, OH 45701
Phone (740) 764-4529

9 Chesapeake Plz
Chesapeake, OH 45619
Phone (740) 297-6019

49 Johnson Rd
The Plains, OH 45780
Phone (740) 764-4529

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/pathihc/r4/

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1730646712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CHESAPEAKE PLZ",
            "city": "CHESAPEAKE",
            "state": "OH",
            "postal_code": "456191003",
            "telephone_number": "740-764-4529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 JOHNSON RD",
            "city": "THE PLAINS",
            "state": "OH",
            "postal_code": "457801146",
            "telephone_number": "740-764-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSE",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-26",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "APP-000218442",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "170009",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730646712",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in The Plains, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.