NPIMap

Individual provider Active NPI

Melissa Lynn Russell, DO

  • Internal Medicine Physician
  • Ventura, CA
National Provider Identifier
1114543998
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A21171 Issued in CA
Practice address
147 N Brent St
Ventura, CA 93003-2809
Phone
(805) 948-5672
NPI assigned
Jun 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20A21171 CA Primary

Addresses

Primary practice location

147 N Brent St
Ventura, CA 93003-2809

Mailing address

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 948-5672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231009001473 CA Practitioner - Internal MedicinePractitioner - Emergency Medicine 0547654782 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Inpatient PhysiciansGroup PAC ID 4789998170, 35 clinicians
Community Memorial Health SystemGroup PAC ID 9537155676, 187 clinicians

Practice addresses (Care Compare)

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 652-5652

2721 E Main St
Ventura, CA 93003-2803
Phone (805) 667-2841

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
21171CAMDDental Hygienist
20A21171CAMDInternal Medicine Physician
1229CAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System CurrentSince Oct 1, 2023 Accepting new patients
Community Memorial Health System Current Accepting new patients
Community Memorial Health System CurrentSince Oct 1, 2023 Accepting new patients
Pacific Inpatient Physicians CurrentSince Aug 26, 2023 Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

2721 E Main St
Ventura, CA 93003
Phone (805) 656-6272

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1114543998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032809",
            "telephone_number": "805-948-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032809",
            "telephone_number": "805-948-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MELISSA",
        "middle_name": "LYNN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-17",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A21171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.