Active NPI
Jeffrey Wyan Russell, MHS, PA-C
- Physician Assistant
- Anchorage, AK
National Provider Identifier
1043332497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 371
- Practice address
- 2741 Debarr Rd
Suite C-308
Anchorage, AK 99508-2953 - Phone
- (907) 272-3366
- Fax
- (907) 272-0269
- NPI assigned
- Apr 5, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 371 | AK | Primary |
Addresses
Primary practice location
2741 Debarr Rd
Suite C-308
Anchorage, AK 99508-2953
Mailing address
PO Box 140386
Anchorage, AK 99514-0386
Phone (907) 277-0972
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA2515 | AK | MD | Family Medicine Physician |
| 371 | AK | MD | Physician Assistant |
Interoperability endpoints
- jeffrey.russellpa.p3@direct.cvr.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043332497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 140386",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995140386",
"telephone_number": "907-277-0972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2741 DEBARR RD",
"address_2": "SUITE C-308",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995082953",
"telephone_number": "907-272-3366",
"fax_number": "907-272-0269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JEFFREY",
"middle_name": "WYAN",
"name_prefix": "Mr.",
"credential": "MHS, PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AK",
"license": "371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.