Andrea Synnestvedt Russell, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801085121 Issued in MI

Practice address

4230 Copper Ridge Dr
Traverse City, MI 49684-7256

Phone

(231) 935-6380

Fax

(231) 935-6920

NPI assigned

Sep 20, 2006

Sex

Female

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 MI

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, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Munson Medical CenterGroup PAC ID 3072426287, shared by 12 NPIs, 377 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Medical Center Hospital, Traverse City, MI, CCN 230097

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

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.

• Munson Medical Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Traverse City, MI
  • NPI 1083761860
  Medicare reassignment NPD
• Munson Medical Center

  • Social Worker
  • Traverse City, MI
  • NPI 1386672665
  Medicare reassignment NPD
• Munson Medical Center

  • Psychiatric Hospital Unit
  • Traverse City, MI
  • NPI 1659385334
  NPD
• Munson Medical Center

  • Psychiatric Hospital Unit
  • Traverse City, MI
  • NPI 1891586103

  Social Worker

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1992803795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 COTTAGEVIEW DR STE 1076",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842614",
            "telephone_number": "231-218-6664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 COPPER RIDGE DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847256",
            "telephone_number": "231-935-6380",
            "fax_number": "231-935-6920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Cottageview Dr Ste 1076",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842614",
            "country_code": "US",
            "telephone_number": "231-218-6664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ANDREA",
        "middle_name": "SYNNESTVEDT",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801085121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Stephen Ruoff, D.O.
• Amy Rushlow, PA
• David C Rushlow, LMSW
• Russell Chiropractic, PLC
• Russell Van Houzen, MD, PLC
• Christine A Russell, MSRD
• Erynne Louise Russell
• Jodi K Russell
• Kerry Bruce Russell, D.C., C.C.S.P.
• Krsity Marie Russell

• Social Worker in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.