Active NPI
Russell Trexler Porter, MD
- Family Medicine Physician
- Modesto, CA
National Provider Identifier
1174545362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A75424
- Practice address
- 1448 Florida Ave
Modesto, CA 95350-4424 - Phone
- (209) 523-1884
- Fax
- (209) 522-6002
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A75424 | CA | Primary |
Addresses
Primary practice location
1448 Florida Ave
Modesto, CA 95350-4424
Mailing address
1448 Florida Ave
Modesto, CA 95350-4424
Phone (209) 523-1884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A754240 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031124000802 | CA | Practitioner - Family Practice | 9739083452 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1448 Florida Ave
Modesto, CA 95350-4424
Phone (209) 523-1884
Hospital & facility affiliations
- Sutter Care at Home
- Adventist Health Sonora
- Memorial Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 32 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles (4 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orangeburg Medical Group | Family Medicine | Current | Accepting new patients |
| Oakdale Medical Group Inc | Past | Accepting new patients | |
| California Em-I Medical Services, a Medical Corporation | Past | Accepting new patients | |
| Memorial Hospital | Past | Accepting new patients |
Locations
1448 Florida Ave
Modesto, CA 95350
Phone (209) 523-1884
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.505006
Organizations & group practices 4
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.
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Hospital & facility affiliations 14
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": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332201600000",
"number": "1174545362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1448 FLORIDA AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504424",
"telephone_number": "209-523-1884",
"fax_number": "209-522-6002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1448 FLORIDA AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504424",
"telephone_number": "209-523-1884",
"fax_number": "209-522-6002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "RUSSELL",
"middle_name": "TREXLER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2012-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A75424",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A754240",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; 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.
- 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.