NPIMap

Organization Active NPI

Russ Physical Therapy LLC

  • Physical Therapist
  • Bentonville, AR
National Provider Identifier
1184014987
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
RUSS PHYSICAL THERAPY LLC
Practice address
1002 Westpark Dr Ste 6
Bentonville, AR 72712-4283
Phone
(479) 250-4014
Fax
(479) 250-4015
NPI assigned
Jan 31, 2015
Last updated
Oct 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Authorized official

Name
Mr. Joe E Russ, PTANPI 1871368811
Title
Owner
Phone
(479) 250-4014

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1002 Westpark Dr Ste 6
Bentonville, AR 72712-4283

Mailing address

1002 Westpark Dr Ste 6
Bentonville, AR 72712-4283
Phone (479) 250-4014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150514000791 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2466772447 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Springdale, AR; Bentonville, AR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Russ Physical Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1002 Westpark Dr
Ste 6
Bentonville, AR 72712
Phone (479) 250-4014

2070 McKenzie Rd
Ste A
Springdale, AR 72762
Phone 4792504014 ext. 2

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1184014987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 WESTPARK DR STE 6",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124283",
            "telephone_number": "479-250-4014",
            "fax_number": "479-250-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 WESTPARK DR STE 6",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124283",
            "telephone_number": "479-250-4014",
            "fax_number": "479-250-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-31",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "RUSS",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-250-4014",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.