Individual provider Active NPI

Ryan P Glass, MSW, LISW

  • Clinical Social Worker
  • Lebanon, OH
National Provider Identifier
1952754335
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-1600232 Issued in OH
Practice address
975 Kingsview Dr
BLDG a
Lebanon, OH 45036-9562
Phone
(513) 228-7800
Fax
(513) 228-7846
NPI assigned
Jul 20, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I-1600232 OH Primary

Addresses

Primary practice location

975 Kingsview Dr
BLDG a
Lebanon, OH 45036-9562

Mailing address

204 Cook Rd
Suite 400
Lebanon, OH 45036-9600
Phone (513) 228-7800

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170224001426 OH Practitioner - Clinical Social Worker 3173807807 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I-1600232OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Psychiatry & Wellness, LLC CurrentSince Mar 1, 2021 Accepting new patients
Modern Psychiatry and Wellness LLC CurrentSince Mar 1, 2021 Accepting new patients
Emerge Recovery and Trades Initiative Past Accepting new patients

Locations

1910 Fairgrove Ave
Ste E
Hamilton, OH 45011
Phone (513) 299-4025

7162 Liberty Centre Dr
Liberty Township, OH 45069
Phone (513) 494-4679

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5507/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.qualifacts.org/api/fhir/mpwhealth/r4/

Organizations & group practices 3

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": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1952754335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 COOK RD",
            "address_2": "SUITE 400",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450369600",
            "telephone_number": "513-228-7800",
            "fax_number": "513-695-2952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 KINGSVIEW DR",
            "address_2": "BLDG A",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450369562",
            "telephone_number": "513-228-7800",
            "fax_number": "513-228-7846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASS",
        "first_name": "RYAN",
        "middle_name": "P",
        "credential": "MSW, LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-1600232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OH

Sources for this page

Verify at the official NPI Registry.