Patrick W Russell, D.O.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

02001219 Issued in IN

Practice address

615 N Michigan St
1St FL Hospitalist Ste
South Bend, IN 46601-1033

Phone

(574) 647-3050

Fax

(574) 647-1094

NPI assigned

Dec 13, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617

  IN

  Medicare reassignment NPD
• Beacon Medical Group, Inc.

  • Critical Care Medicine (Internal Medicine) Physician
  • Elkhart, IN
  • NPI 1821222829

  Neurology

  NPD
• Elkhart General Hospital, Inc.

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1477551489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1144205113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 GREENLEAF BLVD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141365",
            "telephone_number": "574-536-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "address_2": "1ST FL HOSPITALIST STE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-3050",
            "fax_number": "574-647-1094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "PATRICK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "02001219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000000215919",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100114080",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "130024231",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Elaine Rupe Cressy, OCCUPATIONAL THERAPI
• Rush-Select Holdings, LLC
• Kristina Rush, BS
• Jayla Rushing, RBT
• Elizabeth Alexis Russell, DNP, APRN, FNP-BC
• Robert J Rust, M.D.
• Sofia Rutledge, DPT
• Karissa D Ryan, LMHC
• Olivia Suzanne Ryan
• Allison Rykse, DPT

• All providers in South Bend, IN
• Neurology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.