Individual provider Active NPI

Megan Patricia Russell, P.A.

  • Medical Physician Assistant
  • Bronx, NY
National Provider Identifier
1194060400
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
016260 Issued in NY
Practice address
111 E 210TH St
Critical Care Medicine Office
Bronx, NY 10467-2401
Phone
(718) 920-4321
NPI assigned
Nov 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 016260 NY Primary

Addresses

Primary practice location

111 E 210TH St
Critical Care Medicine Office
Bronx, NY 10467-2401

Mailing address

3011 Zulette Ave
Bronx, NY 10461-5619
Phone (914) 309-4266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140128000694 NY Practitioner - Physician Assistant 3274762034 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Nov 15, 2013 Accepting new patients
Montefiore Medical Center CurrentSince Nov 15, 2013 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

111 E 210th St
Ofc
Bronx, NY 10467
Phone (718) 920-2449

Interoperability endpoints

  • Direct secure messaging: mpr9007@direct.nyp.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354060800000",
    "number": "1194060400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 ZULETTE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104615619",
            "telephone_number": "914-309-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "address_2": "CRITICAL CARE MEDICINE OFFICE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MEGAN",
        "middle_name": "PATRICIA",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-28",
        "last_updated": "2012-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "016260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.