NPIMap

Individual provider Active NPI

Kimberly A Russell, MD

  • Family Medicine Physician
  • Kingsland, TX
National Provider Identifier
1174505796
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J6710 Issued in TX
Practice address
105 FM 2342
Kingsland, TX 78639-6010
Phone
(325) 388-9400
Fax
(325) 388-9422
NPI assigned
Nov 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J6710 TX Primary

Addresses

Primary practice location

105 FM 2342
Kingsland, TX 78639-6010

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111

Other identifiers 5

IdentifierTypeStateIssuer
151137001MedicaidTX
152231001MedicaidTX
130873101OtherTXFIRSTCARE
8398K2OtherTXBCBS
82693OtherTXSCOTT WHITE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krussell11421@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20080723000854 TX Practitioner - Family Practice 6608949656 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

1300 E Polk St
Baylor Scott and White Clinic Burnet
Burnet, TX 78611-2136
Phone (512) 715-6400

810 W Hwy 71
Marble Falls Professional Services Group
Marble Falls, TX 78654-8602
Phone (830) 201-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J6710TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Hospital - Marble Falls Family Medicine CurrentSince Oct 15, 2019 Accepting new patients
Scott & White Clinic Family Medicine CurrentSince Mar 14, 2018 Accepting new patients
Scott & White Hospital - Marble Falls CurrentSince Oct 15, 2019 Accepting new patients
Scott & White Clinic Family Medicine CurrentSince Mar 14, 2018 Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

101 E Jackson St
Burnet, TX 78611
Phone (512) 756-7510

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

105 FM 2342
Ste A
Kingsland, TX 78639
Phone (325) 388-8246

105 FM 2342
Kingsland, TX 78639
Phone (325) 388-8246

200 W Ollie St
Llano, TX 78643
Phone (325) 216-9199

102 E Young St
Llano, TX 78643
Phone (325) 247-3138

810 W Highway 71
Marble Falls, TX 78654
Phone (830) 201-7100

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: krussell11421@direct.sw.org

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1174505796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 FM 2342",
            "city": "KINGSLAND",
            "state": "TX",
            "postal_code": "786396010",
            "telephone_number": "325-388-9400",
            "fax_number": "325-388-9422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2020-09-01",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J6710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151137001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152231001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "130873101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8398K2",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCOTT WHITE",
            "identifier": "82693",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krussell11421@direct.sw.org",
            "affiliation": "N",
            "address_1": "105 FM 2342",
            "city": "Kingsland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786396010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kingsland, TX

Sources for this page

Verify at the official NPI Registry.