Rustin Forest Cameron, PA-C
Individual provider Active NPI Physician Assistant · MC Kenzie, TN
NPI 1114211372 · NPPES record last updated Jun 6, 2011
Key facts
- NPI
- 1114211372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 763 Main St N
MC Kenzie, TN 38201-1723 - Phone
- (731) 358-0973
- NPI assigned
- Jun 6, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in VI, NM, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120606000456 | VI | Practitioner - Physician Assistant | 9335303106 | Reassigns benefits to 1 organization |
| I20130531000522 | NM | Practitioner - Physician Assistant | 9335303106 | Reassigns benefits to 3 organizations |
| I20240524000886 | AZ | Practitioner - Physician Assistant | 9335303106 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Governor Juan F. Luis Hospital & Medical Center | Current |
Accepting new patients |
Locations
4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
763 Main St N
MC Kenzie, TN 38201-1723
Mailing address
763 Main St N
MC Kenzie, TN 38201-1723
Phone (731) 358-0973
Other providers in MC Kenzie, TN
- Thomas E Brown
- Michael Lee Bryant
- Brittany Burkett
- Brooke Spivey Burress
- Kenneth T Butler
- Elijah Carpenter
- CCC Medical Equipment, Inc.
- Briana Page Chandler
- Philemon D Chang
- Alice Chapman
All providers in MC Kenzie, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.