Active NPI
Russell William Lake, MD
- Family Medicine Physician
- Richmond Hill, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 75198
- Practice address
- 10055 Ford Avenue
Suite 3a
Richmond Hill, GA 31324 - Phone
- (912) 819-9601
- Fax
- (912) 819-9605
- NPI assigned
- Jul 21, 2008
- Last updated
- Oct 19, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31545 | SC | |
| Family Medicine Physician | 207Q00000X | 75198 | GA | Primary |
Addresses
Primary practice location
10055 Ford Avenue
Suite 3a
Richmond Hill, GA 31324
Mailing address
836 E. 65TH Street
Suite 22
Savannah, GA 31405
Phone (912) 819-7878
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003213522B | Medicaid | GA | |
| 200480198D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Medical University of South Carolina College of Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
10055 Ford Ave
Suite 3a
Richmond Hill, GA 31324-3972
Phone (912) 819-9601
11705 Mercy Blvd
Savannah, GA 31419-1711
Phone (912) 819-4949
Hospital & facility affiliations
- St Joseph's/ Candler Home Healthcare
- Aveanna Home Health
- Amedisys Home Health
- St Joseph's Hospital - Savannah
- Candler Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SJC Medical Group Inc | Family Medicine | Current | Accepting new patients |
Locations
101 Saint Josephs Candler Dr
Ste 200
Pooler, GA 31322
Phone (912) 748-1999
10055 Ford Ave
Ste 3A
Richmond Hill, GA 31324
Phone (912) 355-5593
11705 Mercy Blvd
Savannah, GA 31419
Phone (912) 819-2452
310 Eisenhower Dr
Ste 7A
Savannah, GA 31406
Phone (912) 355-6503
602 E 72nd St
Savannah, GA 31405
Phone (912) 819-7800
836 E 65th St
Ste 22
Savannah, GA 31405
Phone (912) 819-7878
Interoperability endpoints
- drlake@direct.sjchs.org
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.
-
- Family Medicine Physician
- Savannah, GA
- NPI 1811233828
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Savannah, GA
- NPI 1275527889
-
dba Aveanna Home Health
- Home Health Agency
- Pooler, GA
- NPI 1922715127
-
- General Acute Care Hospital
- Savannah, GA
- NPI 1063406684
-
dba St. Joseph's/Candler Home Healthcare
- Home Health Agency
- Hinesville, GA
- NPI 1992799449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634601600000",
"number": "1104081082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "836 E. 65TH STREET",
"address_2": "SUITE 22",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "31405",
"telephone_number": "912-819-7878",
"fax_number": "912-819-3320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10055 FORD AVENUE",
"address_2": "SUITE 3A",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "31324",
"telephone_number": "912-819-9601",
"fax_number": "912-819-9605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "RUSSELL",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-21",
"last_updated": "2021-10-19",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "31545",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "75198",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003213522B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200480198D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond Hill, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.