Jaizane Alexis Russell

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I-2405497 Issued in OH

Practice address

1 Elizabeth PL
Dayton, OH 45417-3445

Phone

(937) 234-0121

NPI assigned

Oct 2, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Samaritan Behavioral Health, Inc.

  • Clinic/Center
  • Dayton, OH
  • NPI 1205888641
  Medicare reassignment
• Samaritan Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Dayton, OH
  • NPI 1235490939
  NPD
• Samaritan Behavioral Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayton, OH
  • NPI 1629022330
  NPD
• National Youth Advocate Program, Inc

  • Community/Behavioral Health Agency
  • Canton, OH
  • NPI 1679721906
  NPD (past)
• National Youth Advocate Program, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Columbus, OH
  • NPI 1952661183
  NPD (past)

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

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1982189247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5244 W 2ND ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454179044",
            "telephone_number": "937-818-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELIZABETH PL",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454173445",
            "telephone_number": "937-234-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JAIZANE",
        "middle_name": "ALEXIS",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-02",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1903283",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-2405497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles E Russell, MD
• Emily Russell
• Geneva Russell
• Gwyneth Russell, RN
• Heather A Russell, CRNA
• Janice Russell, LPN
• Jason Luther Russell, D.O.
• Marsha T Russell, CDCA
• Renee Russell
• Ryan S Russell, LSW

• Clinical Social Worker in Dayton, OH
• Providers in Dayton, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.