Active NPI
Kathryn A Russell, DC
- Chiropractor
- Niceville, FL
National Provider Identifier
1174291975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 13696
- Practice address
- 350 John Sims Pkwy W Unit 401
Niceville, FL 32578-1963 - Phone
- (850) 678-8049
- NPI assigned
- Sep 6, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 13696 | FL | Primary |
Addresses
Primary practice location
350 John Sims Pkwy W Unit 401
Niceville, FL 32578-1963
Mailing address
460 S Rosemary Ave Apt 307
West Palm Beach, FL 33401-5799
Phone (850) 226-3911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
350 John Sims Pkwy W
Unit 401
Niceville, FL 32578-1963
Phone (850) 678-8049
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13696 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ewing Family Chiropractic | Chiropractor | Current | Accepting new patients |
| Gardens Health & Wellness Inc | Chiropractor | Past | Accepting new patients |
Locations
350 John Sims Pkwy W
Unit 401
Niceville, FL 32578
Phone (850) 678-8049
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.
-
- Chiropractor
- Palm Beach Gardens, FL
- NPI 1568530723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687046400000",
"number": "1174291975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 S ROSEMARY AVE APT 307",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334015799",
"telephone_number": "850-226-3911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 JOHN SIMS PKWY W UNIT 401",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325781963",
"telephone_number": "850-678-8049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "KATHRYN",
"middle_name": "A",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-06",
"last_updated": "2023-06-18",
"certification_date": "2023-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "13696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2023; 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.