Active NPI
Russell Teal Bailiff, LCSW
- Clinical Social Worker
- Lindale, TX
National Provider Identifier
1831267699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 29264
- Practice address
- 716 Linus LN
Lindale, TX 75771-6626 - Phone
- (903) 312-7246
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 29264 | TX | Primary |
Addresses
Primary practice location
716 Linus LN
Lindale, TX 75771-6626
Mailing address
PO Box 726
Lindale, TX 75771-0726
Phone (903) 312-7246
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0638405-04 | Medicaid | TX | |
| 0638405-01 | Medicaid | TX | |
| 0013EX | Other | TX | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29264 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464134400000",
"number": "1831267699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 726",
"city": "LINDALE",
"state": "TX",
"postal_code": "757710726",
"telephone_number": "903-312-7246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "716 LINUS LN",
"city": "LINDALE",
"state": "TX",
"postal_code": "757716626",
"telephone_number": "903-312-7246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILIFF",
"first_name": "RUSSELL",
"middle_name": "TEAL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2016-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "29264",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0638405-04",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0638405-01",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0013EX",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lindale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.