Active NPI
Jessica Russ, CCP
- Perfusionist
- Phoenix, AZ
National Provider Identifier
1174929129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- LP030
- Practice address
- 10930 N Tatum Blvd
Ste 103
Phoenix, AZ 85028-6069 - Phone
- (602) 263-7600
- Fax
- (602) 212-0365
- NPI assigned
- Nov 18, 2014
- 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 |
|---|---|---|---|---|
| Perfusionist | 242T00000X | LP030 | NV | Primary |
Addresses
Primary practice location
10930 N Tatum Blvd
Ste 103
Phoenix, AZ 85028-6069
Mailing address
10930 N Tatum Blvd
Ste 103
Phoenix, AZ 85028-6069
Phone (602) 263-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP030 | NV | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416268800000",
"number": "1174929129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10930 N TATUM BLVD",
"address_2": "STE 103",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850286069",
"telephone_number": "602-263-7600",
"fax_number": "602-212-0365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10930 N TATUM BLVD",
"address_2": "STE 103",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850286069",
"telephone_number": "602-263-7600",
"fax_number": "602-212-0365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSS",
"first_name": "JESSICA",
"credential": "CCP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-18",
"last_updated": "2014-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "NV",
"license": "LP030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.