Active NPI
Bohdan Russum
- Adult Companion
- Grass Valley, CA
National Provider Identifier
1104771526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 500 Crown Point Cir
Grass Valley, CA 95945-9561 - Phone
- (415) 847-8420
- NPI assigned
- Mar 2, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | CA | Primary |
Addresses
Primary practice location
500 Crown Point Cir
Grass Valley, CA 95945-9561
Mailing address
10560 Kearney CT
Smartsville, CA 95977-9556
Phone (415) 847-8420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1772409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772409600000",
"number": "1104771526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10560 KEARNEY CT",
"city": "SMARTSVILLE",
"state": "CA",
"postal_code": "959779556",
"telephone_number": "415-847-8420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CROWN POINT CIR",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959459561",
"telephone_number": "415-847-8420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSUM",
"first_name": "BOHDAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-02",
"last_updated": "2026-03-02",
"certification_date": "2026-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.