NPIMap

Individual provider Active NPI

Shelly Rae Russeff, APRN-CNP

  • Family Nurse Practitioner
  • Pauls Valley, OK
National Provider Identifier
1053710053
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0058066 Issued in OK
Practice address
105 N Indian Meridian Rd
Pauls Valley, OK 73075-9236
Phone
(405) 207-9800
Fax
(405) 207-9898
NPI assigned
Aug 15, 2014
Last updated
Mar 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R0058066 OK Primary

Addresses

Primary practice location

105 N Indian Meridian Rd
Pauls Valley, OK 73075-9236

Mailing address

301 E Seminole St Apt 2
Wynnewood, OK 73098-5629
Phone (405) 207-1116

Other names 1

  • Shelly R Robbins Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20151019000323 OK Practitioner - Nurse Practitioner 9638488430 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

105 N Indian Meridian Rd
Pauls Valley, OK 73075-9236
Phone (405) 207-9800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R0058066OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Resource Management, LLC CurrentSince Mar 12, 2020 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Feb 1, 2018 Accepting new patients
Saints Medical Group, LLC CurrentSince Mar 11, 2024 Accepting new patients
Medberry Health PLLC CurrentSince Sep 1, 2022 Accepting new patients
Saints Medical Group, LLC CurrentSince Mar 11, 2024 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Feb 1, 2018 Accepting new patients
State of Oklahoma Past Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients
Purcell Municipal Hospital Past Accepting new patients
Wynnewood Urgent Care and Immediate Care Center PC Past Accepting new patients

Locations

10701 N Rockwell Ave
Oklahoma City, OK 73162
Phone (405) 470-1500

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

105 N Indian Meridian Rd
Pauls Valley, OK 73075
Phone (405) 207-9800

10717 N May Ave
Ste A
The Village, OK 73120
Phone (405) 849-5959

2929 S Garnett Rd
Tulsa, OK 74129
Phone (918) 665-1520

4749 Fredericksburg Rd
Ste A
San Antonio, TX 78229
Phone (210) 997-8630

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: srusseff508596@direct-ehr-ssmhc.com

Organizations & group practices 10

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.

Hospital & facility affiliations 7

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": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1053710053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E SEMINOLE ST APT 2",
            "city": "WYNNEWOOD",
            "state": "OK",
            "postal_code": "730985629",
            "telephone_number": "405-207-1116",
            "fax_number": "405-665-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N INDIAN MERIDIAN RD",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730759236",
            "telephone_number": "405-207-9800",
            "fax_number": "405-207-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSEFF",
        "first_name": "SHELLY",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "APRN-CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-15",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0058066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "ROBBINS",
            "middle_name": "R",
            "credential": "APRN-CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pauls Valley, OK

Sources for this page

Verify at the official NPI Registry.