Individual provider Active NPI

Deirdre A Russell, PA-C

  • Physician Assistant
  • Allentown, PA
National Provider Identifier
1104150788
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
TMA052143 Issued in PA
Practice address
1250 S Cedar Crest Blvd
Suite 110
Allentown, PA 18103-6224
Phone
(610) 435-1003
Fax
(610) 435-3184
NPI assigned
Sep 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X TMA052143 PA Primary

Addresses

Primary practice location

1250 S Cedar Crest Blvd
Suite 110
Allentown, PA 18103-6224

Mailing address

1250 S Cedar Crest Blvd
Suite 110
Allentown, PA 18103-6224
Phone (610) 435-1003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091119000198 PA Practitioner - Physician Assistant 5991843559 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

1200 S Cedar Crest Blvd 3Rd FL Kasych
LVPG Burn Surgery
Allentown, PA 18103-6202
Phone (610) 402-8355

1200 S Cedar Crest Blvd FL
1 LVPG Nephrology
Allentown, PA 18103-6202
Phone (610) 402-8510

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

2545 Schoenersville Rd
Bethlehem, PA 18017-7300

Hospital & facility affiliations

  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
TMA052143PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Dec 1, 2014 Accepting new patients
Lehigh Valley Physician Group CurrentSince Dec 1, 2014 Accepting new patients
Pulmonary Associates PC Past Accepting new patients

Locations

798 Hausman Rd
Fl 1
Allentown, PA 18104

1210 S Cedar Crest Blvd
Ste 3300
Allentown, PA 18103
Phone (610) 402-8506

1250 S Cedar Crest Blvd
Ste 110
Allentown, PA 18103
Phone (610) 435-1003

1621 N Cedar Crest Blvd
Allentown, PA 18104
Phone (610) 402-3300

2775 Schoenersville Rd
Bethlehem, PA 18017

111 Switzgabel Dr
Brodheadsville, PA 18322
Phone (570) 369-1004

505 Independence Rd
East Stroudsburg, PA 18301
Phone (484) 862-3001

3371 Route 100
Macungie, PA 18062
Phone (610) 336-8277

1120 Oak St
Pittston Township, PA 18640
Phone (570) 299-3384

320 W Pumping Station Rd
Quakertown, PA 18951
Phone (215) 529-4240

241 Claremont Ave
Tamaqua, PA 18252
Phone (570) 225-7211

Interoperability endpoints

  • Direct secure messaging: drussell8109@direct2.lvhn.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1254182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414972800000",
    "number": "1104150788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 S CEDAR CREST BLVD",
            "address_2": "SUITE 110",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036224",
            "telephone_number": "610-435-1003",
            "fax_number": "610-435-3184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 S CEDAR CREST BLVD",
            "address_2": "SUITE 110",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036224",
            "telephone_number": "610-435-1003",
            "fax_number": "610-435-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "DEIRDRE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-29",
        "last_updated": "2014-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "TMA052143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.