Active NPI
Georgia Russell, APRN
- Family Nurse Practitioner
- Moab, UT
National Provider Identifier
1073785408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209410-4405
- Practice address
- 450 Williams Way
Moab, UT 84532 - Phone
- (435) 719-3510
- Fax
- (435) 719-3509
- NPI assigned
- Mar 26, 2008
- Last updated
- Aug 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209410-4405 | UT | Primary |
Addresses
Primary practice location
450 Williams Way
Moab, UT 84532
Mailing address
450 Williams Way
Moab, UT 84532-2185
Phone (435) 719-3510
Other practice location 1
719 West 400 North
Moab, UT 84532
Phone (435) 259-7191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Interoperability endpoints
- georgiar@mrhmoab.securechart.com
Organizations & group practices 1
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.
-
dba Moab Regional Hospital
- Critical Access Hospital
- Moab, UT
- NPI 1770513236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534377600000",
"number": "1073785408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 WILLIAMS WAY",
"city": "MOAB",
"state": "UT",
"postal_code": "845322185",
"telephone_number": "435-719-3510",
"fax_number": "435-719-3509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 WILLIAMS WAY",
"city": "MOAB",
"state": "UT",
"postal_code": "84532",
"telephone_number": "435-719-3510",
"fax_number": "435-719-3509"
}
],
"practiceLocations": [
{
"address_1": "719 West 400 North",
"address_purpose": "LOCATION",
"city": "Moab",
"state": "UT",
"postal_code": "84532",
"country_code": "US",
"telephone_number": "435-259-7191",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RUSSELL",
"first_name": "GEORGIA",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-26",
"last_updated": "2018-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "209410-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moab, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.