NPIMap

Individual provider Active NPI

Richard L Russell, M.D.

  • Internal Medicine Physician
  • Madison, MS
National Provider Identifier
1063584175
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
14431 Issued in MS
Practice address
106 Highland Way Ste 200
Madison, MS 39110-6933
Phone
(601) 200-4141
Fax
(601) 200-4150
NPI assigned
Nov 14, 2006
Last updated
Feb 26, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 14431 MS Primary

Addresses

Primary practice location

106 Highland Way Ste 200
Madison, MS 39110-6933

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

Other identifiers 1

IdentifierTypeStateIssuer
00126047MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20101227000376 MS Practitioner - Internal Medicine 2365630977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Mississippi School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

106 Highland Way
Madison, MS 39110-6933

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Dominic Medical Associates LLC CurrentSince Aug 1, 2014 Accepting new patients
St. Dominic Medical Associates LLC CurrentSince Aug 1, 2014 Accepting new patients
Premier Medical Management of Mississippi, Inc Past Accepting new patients
St Dominic Medical Associates LLC Past Accepting new patients

Locations

106 Highland Way
Ste 200
Madison, MS 39110
Phone (601) 200-4141

106 Highland Way
Ste 202
Madison, MS 39110
Phone (601) 200-3376

Interoperability endpoints

  • Direct secure messaging: rrussell2548783@direct.casso.us.com

Organizations & group practices 4

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1063584175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 HIGHLAND WAY STE 200",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106933",
            "telephone_number": "601-200-4141",
            "fax_number": "601-200-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "RICHARD",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "14431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00126047",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

Verify at the official NPI Registry.