Active NPI
Russell C Cantrell, M.D.
- Physical Medicine & Rehabilitation Physician
- Saint Louis, MO
National Provider Identifier
1023097904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 103654
- Practice address
- 1001 S. Kirkwood Road
Suite 120
Saint Louis, MO 63122-7250 - Phone
- (314) 966-8887
- Fax
- (314) 966-3869
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 103654 | MO | Primary |
Addresses
Primary practice location
1001 S. Kirkwood Road
Suite 120
Saint Louis, MO 63122-7250
Mailing address
PO Box 843857
Kansas City, MO 64184-3857
Phone (314) 966-8887
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0425207002 | Other | MO | CIGNA |
| 227927 | Other | MO | HEALTHLINK |
| 4486251 | Other | MO | AETNA |
| 18346 | Other | MO | BLUE CROSS BLUE SHIELD |
| 2300015 | Other | MO | UNITED HEALTH CARE |
| 49861 | Other | MO | GREAT WEST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100908000797 | MO | Practitioner - Physical Medicine and Rehabilitation | 0749387470 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103654 | MO | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1023097904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 843857",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641843857",
"telephone_number": "314-966-8887",
"fax_number": "314-966-3869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 S. KIRKWOOD ROAD",
"address_2": "SUITE 120",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631227250",
"telephone_number": "314-966-8887",
"fax_number": "314-966-3869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANTRELL",
"first_name": "RUSSELL",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MO",
"license": "103654",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0425207002",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "227927",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4486251",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "18346",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "2300015",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT WEST",
"identifier": "49861",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.