Russell C Cowan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03054 Issued in TX

Practice address

2112 Hwy 1431
Kingsland, TX 78639-6010

Phone

(325) 388-3515

Fax

(325) 388-9417

NPI assigned

Nov 21, 2005

Last updated

Oct 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Llano Regional Hospital

  dba Scott & White Hospital - Llano, Professional Services

  • Family Medicine Physician
  • Llano, TX
  • NPI 1457652745

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1164405403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W OLLIE ST",
            "city": "LLANO",
            "state": "TX",
            "postal_code": "786432628",
            "telephone_number": "325-247-5040",
            "fax_number": "325-248-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 HWY 1431",
            "city": "KINGSLAND",
            "state": "TX",
            "postal_code": "786396010",
            "telephone_number": "325-388-3515",
            "fax_number": "325-388-9417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COWAN",
        "first_name": "RUSSELL",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Ann Brooks, FNP
• Central Texas Family Dentistry PC
• Central TX Chiropractic & Rehabilitation Clinics, Inc
• Concho County Hospital (Kingsland Hills Care Center)
• Adrienne Van Erp Cowan, OTR/L
• Christina Susan Deloach, MED, LPC
• James P Donohue, PA
• Dura Med, Inc. (Bowen's Pharmacy and Medical Equipment)
• Duramed Inc (Bowens Health Mart Pharmacy)
• Fannin County Hospital Authority (Avir at Kingsland)

• Physician Assistant in Kingsland, TX
• Providers in Kingsland, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.