MRS. MICHELLE K RUSBOLDT (LCSW) – Clinical Social Worker, NPI 1366817165

MRS. MICHELLE K RUSBOLDT (LCSW) is a healthcare provider. based in Green bay, Wisconsin. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LCSW. They hold a License No. 127961-121 (WI). The NPI Number for MRS. MICHELLE K RUSBOLDT (LCSW) is 1366817165

Main info

Female
18 Years Of Experience
Accepts Medicare Assignment
Name
MRS. MICHELLE K RUSBOLDT (LCSW)
NPI
1366817165
Phone
(920) 431-2500
Address
2851 University Ave
Enumeration Date
4 December 2015
Last Update Date
8 December 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9207937300
Graduation Year
2008 (18 years ago)
PAC ID
4082974126
Group Practice PAC ID
6709794258
Professional Enrollment ID
I20180209000020
Address ID
WI542413923TW5300XDRXX300
Telehealth
Yes

Contacts

Secure Messaging
mrusboldt194641@direct.myadvocateaurora.org
FHIR Endpoint
https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience44
Completeness85
Years active:10State licenses:1Other namesUpdated within 12 months

1,447 CLINICAL SOCIAL WORKER in WI

Provider Addresses for MRS. MICHELLE K RUSBOLDT (LCSW)

  • 2851 University Ave

    Green Bay, WI 543115855

    Phone: (920) 431-2500

    Type: Location

  • 5300 MEMORIAL DR

    TWO RIVERS, WI 542413923

    Phone: (920) 793-7420

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-02-09

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20180209000020IClinical Social WorkerWITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90837Psychotherapy, 1 hour9720$0
90834Psychotherapy, 45 minutes8022$0
View full utilization report →

Insurance plans in this area (ZIP 54311)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6709794258View full group profile

Reviews

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Frequently asked questions

What is MRS. MICHELLE K RUSBOLDT (LCSW)'s NPI number?
MRS. MICHELLE K RUSBOLDT (LCSW)'s NPI is 1366817165 — the number used across U.S. healthcare to identify this provider.
Is MRS. MICHELLE K RUSBOLDT (LCSW) still an active registrant?
MRS. MICHELLE K RUSBOLDT (LCSW) carries an active NPI according to the public dataset.
What clinical focus is listed for MRS. MICHELLE K RUSBOLDT (LCSW)?
At a glance, MRS. MICHELLE K RUSBOLDT (LCSW) is tied to Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What practice footprint exists for MRS. MICHELLE K RUSBOLDT (LCSW)?
Travel planning: use Green Bay, Wisconsin as the reference point for MRS. MICHELLE K RUSBOLDT (LCSW), then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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