Jacob Robert Rusczek, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048.0121887 Issued in VT

Practice address

301 River St Ste 204
Montpelier, VT 05602-4303

Phone

(802) 552-0548

NPI assigned

Jul 17, 2017

Last updated

Jul 17, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Jacob Rusczek PHD PLLC

  • Adult Mental Health Clinic/Center
  • Montpelier, VT
  • NPI 1114796489
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500249600000",
    "number": "1932622461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 WILDER ST APT 5",
            "city": "MONTPELIER",
            "state": "VT",
            "postal_code": "056023818",
            "telephone_number": "802-505-5026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 RIVER ST STE 204",
            "city": "MONTPELIER",
            "state": "VT",
            "postal_code": "056024303",
            "telephone_number": "802-552-0548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSCZEK",
        "first_name": "JACOB",
        "middle_name": "ROBERT",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-17",
        "last_updated": "2017-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048.0121887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corina Rose
• Lori Rae Rose, R.P.T.
• Sean Francis Rosetta, BA
• Charles August Rossi
• Jeff Rothenberg, LCMHC
• Erin Marie Carroll Russell, M.A., BCBA
• Lydia Slocum Russell, LCMHC
• Ryan Stanton PLC
• Sage Naturopathic Health LLC
• Paul J Sahba, LCMHC

• Clinical Psychologist in Montpelier, VT
• Providers in Montpelier, VT by specialty
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2017; 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.

Verify at the official NPI Registry.