Russell W Brown II, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085002271 Issued in IL

Practice address

7 S Hospital Dr
Murphysboro, IL 62966-3333

Phone

(618) 519-9200

Fax

(618) 687-1859

NPI assigned

Aug 18, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14668/brand/2/csg/1/fhir/r4

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003920034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-519-9200",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 S HOSPITAL DR",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629663333",
            "telephone_number": "618-519-9200",
            "fax_number": "618-687-1859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "RUSSELL",
        "middle_name": "W",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085002271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "043448",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "10019630",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080129117",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143870",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "174143",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melinda Luanne Bloos, PH.D.
• Richard Earl Boren, CRNA
• Andrea Deneen Brewer, PMHNP-BC
• Zeppelyn Dawn Brewer, M.S. CCC-SLP
• Kimberly Renee McCutchen Brooks, LCSW
• Linda Ann Bunselmeyer, MS, OTR/L
• Tanya Burash
• Nicole Renee Burkett
• Gloria L Canaley, APN
• Julie Ann Cannell, LCPC

• Medical Physician Assistant in Murphysboro, IL
• Providers in Murphysboro, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.