NPIMap

Individual provider Active NPI

Joshua Russell, PA-C

  • Physician Assistant
  • Polson, MT
National Provider Identifier
1013485952
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
70011 Issued in MT
Practice address
106 Ridgewater Dr Ste a
Polson, MT 59860-8977
Phone
(406) 883-3200
Fax
(406) 883-9483
NPI assigned
Nov 8, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 70011 MT Primary

Addresses

Primary practice location

106 Ridgewater Dr Ste a
Polson, MT 59860-8977

Mailing address

106 Ridgewater Dr Ste a
Polson, MT 59860-8977
Phone (406) 883-3200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181231001889 MT Practitioner - Physician Assistant 2769498658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kalispell Regional Medical Center IncGroup PAC ID 5294644381, 422 clinicians

Practice addresses (Care Compare)

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 751-6725

320 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 756-3526

350 Heritage Way
Kalispell, MT 59901-3167

8299 Mt Hwy 35
Bigfork, MT 59911-3583
Phone (406) 837-5541

Hospital & facility affiliations

  • Logan Health Home Care Home health agency, Kalispell, MT, CCN 277053
  • Logan Health Medical Center Hospital, Kalispell, MT, CCN 270051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
70011MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Nov 16, 2018 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients

Locations

8299 MT Highway 35
Bigfork, MT 59911
Phone (406) 837-5499

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

106 Ridgewater Dr
Ste A
Polson, MT 59860
Phone (406) 883-3200

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1013485952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 RIDGEWATER DR STE A",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598608977",
            "telephone_number": "406-883-3200",
            "fax_number": "406-883-9483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 RIDGEWATER DR STE A",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598608977",
            "telephone_number": "406-883-3200",
            "fax_number": "406-883-9483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JOSHUA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-08",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "70011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "106 Ridgewater Dr Ste A",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598608977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Polson, MT

Sources for this page

Verify at the official NPI Registry.