Individual provider Active NPI

Holly L Russell, NP

  • Nurse Practitioner
  • Bedford, IN
National Provider Identifier
1104338623
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71007594A Issued in IN
Practice address
2900 16TH St
Bedford, IN 47421-3510
Phone
(812) 275-1200
NPI assigned
Oct 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71007594A IN Primary

Addresses

Primary practice location

2900 16TH St
Bedford, IN 47421-3510

Mailing address

550 S Landmark Ave
Bloomington, IN 47403-3239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20171101003648 IN Practitioner - Nurse Practitioner 2062778376 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians
Indiana University Health Southern Indiana Physicians LLCGroup PAC ID 6204748197, 474 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

2651 E Discovery Pkwy
Bloomington, IN 47408-9059
Phone (812) 353-9250

2900 16TH St
Bedford, IN 47421-3510
Phone (888) 484-3258

707 W 2ND St
Bloomington, IN 47403-2209
Phone (888) 484-3258

719 W 2ND St
Bloomington, IN 47403-2209
Phone (888) 484-3258

727 W 2ND St
Bloomington, IN 47403-2209
Phone (888) 484-3258

Hospital & facility affiliations

  • Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051
  • Indiana University Health Bedford Hospital Hospital, Bedford, IN, CCN 151328

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71007594AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC Nurse Practitioner CurrentSince Jan 1, 2026 Accepting new patients
Indiana University Health Paoli Inc CurrentSince Jan 1, 2021 Accepting new patients
Indiana University Health Paoli Inc CurrentSince Jan 1, 2021 Accepting new patients

Locations

7992 Solution Ctr
Chicago, IL 60677

2900 16th St
Bedford, IN 47421
Phone (812) 275-1200

727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450

550 S Landmark Ave
Bloomington, IN 47403
Phone (812) 330-3688

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

642 W Hospital Rd
Paoli, IN 47454
Phone (812) 723-2811

560 W Longest St
Paoli, IN 47454
Phone (812) 723-7437

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1508889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1104338623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 16TH ST",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474213510",
            "telephone_number": "812-275-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "HOLLY",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-25",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71007594A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, IN

Sources for this page

Verify at the official NPI Registry.