CMS-1500 Box 24J / 33a • NPI
1104887140
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
364SP0812X (CMS 89)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Clinical Nurse Specialist, Psychiatric — Mental Health, Community
Box 32 Service Location & ZIP+4
1322 N RIVER RD, ST CLAIR, MI, 48079
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1104887140 (SHERRY A RUSSELL, MSN APRN BC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1104887140 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | SHERRY A RUSSELL, MSN APRN BC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Clinical Nurse Specialist, Psychiatric — Mental Health, Community NUCC Code: 364SP0812X (Clinical Nurse Specialist, Psych/Mental Health, Community) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1322 N RIVER RD, ST CLAIR, MI, 48079 |
| Practice Telephone / Fax | Tel: (810) 329-4798 | Fax: (810) 329-7303 |
| Administrative Mailing Address | 1322 N RIVER RD, ST CLAIR, MI, 48079 |
| Enumeration & Last Sync | Enumerated: 2006-03-29 | CMS Record Updated: 2010-07-19 |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (364SP0812X)
What Does Taxonomy Code 364SP0812X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 364SP0812X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Clinical Nurse Specialist, Psychiatric — Mental Health, Community"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (SHERRY A RUSSELL, MSN APRN BC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
364SP0812X — Clinical Nurse Specialist, Psych/Mental Health, CommunityPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Clinical Nurse Specialist, Psychiatric — Mental Health, Community | State: MI | License: 4704167606 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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