Russell Lynn Vollmer, LCSW
Individual provider Active NPI Social Worker · Malad City, ID
NPI 1962813253 · NPPES record last updated Mar 6, 2023
Key facts
- NPI
- 1962813253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 286822-3501 (UT)
- Practice address
- 215 E 50 S Ste 5
Malad City, ID 83252-2300 - Phone
- (208) 766-2365
- Fax
- (208) 766-2364
- NPI assigned
- May 8, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Catholic Health Initiatives Colorado
Practice addresses (Care Compare)
3336 S 4155
West Valley City, UT 84120
82 S 1100
Suite 103
Salt Lake City, UT 84102-1889
Phone (801) 505-5370
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID, UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180117001216 | ID | Practitioner - Clinical Social Worker | 4587888938 | Reassigns benefits to 1 organization |
| I20211025002661 | UT | Practitioner - Clinical Social Worker | 4587888938 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 286822-3501 | UT | MD | Social Worker |
| LCSW-36911 | ID | MD | Clinical Social Worker |
| LSW-28623 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Group of Utah Inc | Current |
Accepting new patients | |
| T Help | Clinical | Current |
Accepting new patients |
| Catholic Health Initiatives Colorado | Current |
Accepting new patients | |
| Catholic Health Initiatives Colorado | Current | Accepting new patients | |
| Catholic Health Initiatives Colorado | Current |
Accepting new patients |
Locations
4737 S Afton Pl
#A
Pocatello, ID 83202
Phone (208) 251-4951
82 S 1100 E
Ste 103
Salt Lake Cty, UT 84102
Phone (801) 505-5370
2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866
3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810
4052 W Pioneer Pkwy
Ste 105
West Valley City, UT 84120
Phone (801) 554-3420
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 286822-3501 | UT | |
| Clinical Social Worker | 1041C0700X | LCSW-36911 | ID | |
| Clinical Social Worker | 1041C0700X | LSW-28623 | ID | |
| Social Worker | 104100000X | 286822-3501 | UT | Yes |
Addresses
Primary practice location
215 E 50 S Ste 5
Malad City, ID 83252-2300
Mailing address
2672 N 3100 W
Malad City, ID 83252-6519
Phone (208) 637-9813
Other providers in Malad City, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.