Marion Christine Ross, L.C.S.W.
Individual provider Active NPI Social Worker · Madison, MS
NPI 1992709570 · NPPES record last updated Jul 13, 2018
Key facts
- NPI
- 1992709570
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- C2287 (MS)
- Practice address
- 133 Executive Dr Ste a
Madison, MS 39110 - Phone
- (601) 665-2047
- Fax
- (800) 476-4191
- NPI assigned
- Jun 10, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
133 Executive Dr
Suite a
Madison, MS 39110-8440
Phone (601) 665-2047
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- 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 |
|---|---|---|---|---|
| I20040923000753 | MS | Practitioner - Clinical Social Worker | 7618945965 |
Reassigns benefits to 1 organization Practice locations: Madison, MS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C2287 | MS | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fitness Clinic Wellness | Current |
Accepting new patients | |
| Preferred PHP LLC | Past |
Accepting new patients | |
| Cac Therapy Group, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | C2287 | MS | Yes |
Addresses
Primary practice location
133 Executive Dr Ste a
Madison, MS 39110
Mailing address
133 Executive Dr Ste a
Madison, MS 39110-8440
Phone (601) 665-2047
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04478331 | Medicaid | MS |
Other providers in Madison, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2018. 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.