Shane T Russell, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

35086518 Issued in OH

Practice address

6780 Loop Rd
Dayton, OH 45459-2161

Phone

(937) 434-6344

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Middletown Surgical Associates

  • Specialist
  • Dayton, OH
  • NPI 1932248572
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1174558803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6780 LOOP RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454592161",
            "telephone_number": "937-434-6344",
            "fax_number": "937-434-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6780 LOOP RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454592161",
            "telephone_number": "937-434-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SHANE",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OH",
            "license": "35086518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Russell, LPN
• Jason Luther Russell, D.O.
• Marsha T Russell, CDCA
• Renee Russell
• Ryan S Russell, LSW
• Shannon Russell, CTRS
• Shannon Russell, QMHS/CDCA
• Vicki E Russell, LISW
• Elizabeth Rust, PEER SUPPORT
• Shelly Rustagi, MD

• Specialist in Dayton, OH
• Providers in Dayton, OH by specialty
• Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.