Russell Petty, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3895 Issued in ND

Practice address

Highway 281 North
Cando, ND 58324-0688

Phone

(701) 968-2541

Fax

(701) 968-2574

NPI assigned

Jul 12, 2006

Last updated

Jul 9, 2007By 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Center for Solutions, P.C.

  dba Center for Solutions

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Devils Lake, ND
  • NPI 1780840223
  NPD (past)
• Clinic Pharmacy Inc

  • Community/Retail Pharmacy
  • Devils Lake, ND
  • NPI 1184718876
  NPD (past)
• Emergency Ambulance of Devils Lake

  dba Lake Region Ambulance Service

  • Land Ambulance
  • Devils Lake, ND
  • NPI 1679591929
  NPD (past)
• Transitional Living Center Inc

  • Substance Abuse Rehabilitation Facility
  • Devils Lake, ND
  • NPI 1255656765
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1043245277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 688",
            "city": "CANDO",
            "state": "ND",
            "postal_code": "583240688",
            "telephone_number": "701-968-2541",
            "fax_number": "701-968-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 281 NORTH",
            "city": "CANDO",
            "state": "ND",
            "postal_code": "583240688",
            "telephone_number": "701-968-2541",
            "fax_number": "701-968-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "RUSSELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "3895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "24029",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12622",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "21510",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casey Myklebust, PA
• Neumann Drug Inc
• Neumann Rexall Drug
• Lana Nicholas, DC
• Brittany Rose Peterson, DPT
• Samantha Sears
• Jennifer Jo Spatola, LCAC
• Paige Nelleen Sullivan
• Brock Benjamin Thomas, CEO
• Shari Timms

• Family Medicine Physician in Cando, ND
• Providers in Cando, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.