Individual provider Active NPI

Christopher Gavin Russell, D.C.

  • Chiropractor
  • Southgate, MI
National Provider Identifier
1154738144
Registry record updated Jul 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010232 Issued in MI
Practice address
15195 Allen Rd
Southgate, MI 48195-2921
Phone
(734) 284-9800
NPI assigned
Jul 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301010232 MI Primary

Addresses

Primary practice location

15195 Allen Rd
Southgate, MI 48195-2921

Mailing address

15195 Allen Rd
Southgate, MI 48195-2921

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140916001677 MI Practitioner - Chiropractic 7416176946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Russell Chiropractic Health PCGroup PAC ID 8921189242, 2 clinicians

Practice addresses (Care Compare)

15195 Allen Rd
Southgate, MI 48195-2921
Phone (734) 284-9800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301010232MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Russell Chiropractic Health P.C. Chiropractor CurrentSince Aug 25, 2014 Accepting new patients
Odette Chiropractic Family Health Center PLC Chiropractor PastSince Aug 25, 2014 Accepting new patients

Locations

15195 Allen Rd
Southgate, MI 48195
Phone (734) 284-9800

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406678400000",
    "number": "1154738144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15195 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15195 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952921",
            "telephone_number": "734-284-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CHRISTOPHER",
        "middle_name": "GAVIN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.