Active NPI
Russell E Phillips, M.D.
- Psychiatry Physician
- Haverford, PA
National Provider Identifier
1013085455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD015455E
- Practice address
- 239 Valley Ridge Rd
Haverford, PA 19041-2028 - Phone
- (610) 896-5710
- Fax
- (610) 896-1667
- NPI assigned
- Dec 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD015455E | PA | Primary |
Addresses
Primary practice location
239 Valley Ridge Rd
Haverford, PA 19041-2028
Mailing address
239 Valley Ridge Rd
Haverford, PA 19041-2028
Phone (610) 896-5710
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 125370300 | Other | DEPT OF LABOR, OWCP | |
| PH126779 | Other | PA | HIGHMARK BLUE SHIELD |
| 0056423000 | Other | PA | INDEPENDENCE BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 3, 2022 through Jan 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668556800000",
"number": "1013085455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 VALLEY RIDGE RD",
"city": "HAVERFORD",
"state": "PA",
"postal_code": "190412028",
"telephone_number": "610-896-5710",
"fax_number": "610-896-1667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "239 VALLEY RIDGE RD",
"city": "HAVERFORD",
"state": "PA",
"postal_code": "190412028",
"telephone_number": "610-896-5710",
"fax_number": "610-896-1667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "RUSSELL",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-02",
"last_updated": "2022-11-16",
"certification_date": "2022-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD015455E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR, OWCP",
"identifier": "125370300",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "PH126779",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "0056423000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Haverford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.