MR. RUSSELL W DERN (NPI# 1568438497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568438497 |
| Entity Type | Individual |
| Full Name | MR. RUSSELL W DERN |
| Credential | PH.D |
| Practice Address |
975 Kingsivew Drive Bldg A Lebanon OH 45036-9562 |
| Mailing Address |
204 Cook Rd Suite 400 Lebanon OH 45036-9600 |
| Practice Telephone | 5132287800 |
| Practice Fax Number | 5132287846 |
| Mailing Telephone | 5132287800 |
| Mailing Fax Number | 5137252231 |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2018-05-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
3444 | OH | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | CAQH | 11489916 | 01 |
| OH | 0630884 | 05 | |
| OH | ANTHEM PIN | 000000012343 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 953 S South St, Wilmington, OH 451772921 | 9373834441 | 9373832916 |
| Street Address |
975 KINGSIVEW DRIVE BLDG A |
| City | LEBANON |
| State | OH |
| Zip Code | 45036-9562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528513728 | Mandy A Blanton | Case Manager/Care Coordinator | 975 Kingsivew Drive, Bldg B, Lebanon, OH 45036-9562 | 2016-08-18 |
| 1538448766 | Jacob P Bergstedt | Marriage & Family Therapist | 975 Kingsivew Drive, Bldg A, Lebanon, OH 45036-9562 | 2011-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479458 | Natasha Denney Arentz | Nurse Practitioner | 5787 Oh-63, Lebanon, OH 45036 | 2019-10-21 |
| 1265086573 | Eric Stone | Counselor | 5234 Oh-63, Lebanon, OH 45036 | 2019-07-25 |
| 1548730401 | Crystal Prater | Counselor | 5234 W Sr 63, Lebanon, OH 45036 | 2018-12-04 |
| 1922574284 | Ellen L Fink | Counselor | 5234 Sr 63, Lebanon, OH 45036 | 2018-10-15 |
| 1255832275 | Primary Care Partners of Ohio | Family Medicine | 726 E Main St Ste F205, Lebanon, OH 45036 | 2018-02-25 |
| 1548769599 | Chelsea R Perkins | Case Manager/Care Coordinator | 975 Kingsview Drive Bldg B, Lebanon, OH 45036 | 2018-02-06 |
| 1184133829 | Mary Bennett | Speech-Language Pathologist | 6760 Oh St Rt. 34, Lynchburg, OH 45036 | 2017-09-26 |
| 1699292912 | Robert Earl Offutt | Counselor | 5234 State Rt.63, Lebanon, OH 45036 | 2017-08-28 |
| 1407381528 | Kari Bump | Counselor | 320 E Silver St, Lebanon, OH 45036 | 2017-04-26 |
| 1154780435 | Ohio Department of Rehabilitation and Correction | Public Health or Welfare | State Route 63, Lebanon, OH 45036 | 2016-02-16 |
| Find all providers in zip 45036 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255821294 | William D. Campagna | Psychologist | 1220 State Route 31, Ste. 19, Lebanon, NJ 08833 | 2018-05-15 |
| 1881196376 | Allied Health Professionals | Psychologist | 3056 Horn Springs Road, Lebanon, TX 37087-1953 | 2018-03-01 |
| 1972904894 | Mujgan Inciler | Psychologist | 5787 State Route 63, C/o Wci, Lebanon, OH 45036 | 2014-09-10 |
| 1871992578 | Samantha Robin Wertheimer | Psychologist | 1202 Ash Lane, Lebanon, PA 17042-9626 | 2014-08-19 |
| 1295062156 | Danielle Tope | Psychologist | 48 Williams Crossing Rd, Lebanon, CT 06249-1339 | 2009-11-12 |
| 1104048727 | Paul J Walker Sr. | Psychologist | 5787 St Route 63, Lebanon, OH 45036 | 2007-05-03 |
| 1235274275 | John Tilghman Hower | Psychologist | 195 N Cornwall Rd E, Lebanon, PA 17042-9014 | 2007-02-20 |
| 1396808531 | Dale K Horst | Psychologist | 15 S 9th St, Lebanon, PA 17042-5104 | 2006-12-19 |
| 1578645974 | Georgette Ventura | Psychologist | 511 Noble St, Lebanon, PA 17042-6322 | 2006-10-19 |
| 1205847837 | Diane P Hoover | Psychologist | 1700 South Lincoln Ave (690), Lebanon, PA 17042 | 2006-08-10 |
| Find all providers in LEBANON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.