Active NPI
Jeff Russ, PT
- Physical Therapist
- Beech Grove, IN
National Provider Identifier
1023627023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05009096A
- Practice address
- 1300 Albany St
Beech Grove, IN 46107-1536 - Phone
- (317) 782-7200
- NPI assigned
- Jul 24, 2020
- 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 Therapist | 225100000X | 05009096A | IN | Primary |
Addresses
Primary practice location
1300 Albany St
Beech Grove, IN 46107-1536
Mailing address
3200 Cold Spring Rd Apt 220
Indianapolis, IN 46222-1960
Phone (317) 361-5293
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05009096A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595548800000",
"number": "1023627023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 COLD SPRING RD APT 220",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462221960",
"telephone_number": "317-361-5293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 ALBANY ST",
"city": "BEECH GROVE",
"state": "IN",
"postal_code": "461071536",
"telephone_number": "317-782-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSS",
"first_name": "JEFF",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-24",
"last_updated": "2020-07-24",
"certification_date": "2020-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05009096A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beech Grove, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.