Providergenix LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PROVIDERGENIX LLC

Doing business as

Providergenix Healthcare Services

Practice address

3100 E 45TH St Ste 234
Cleveland, OH 44127-1091

Phone

(419) 406-0067

Fax

(866) 309-3044

NPI assigned

Nov 15, 2020

Last updated

Nov 15, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Lee Russell, DNP, CNP, FNP-CNPI 1881186971

Title

Ceo

Phone

(419) 406-0067

Specialties & licenses 13

Addresses

Other names 1

• Providergenix Healthcare Services Doing business as

Locations

Practitioners 1

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.

• Thomas Lee Russell, DNP, FNP-C, PMHNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Middle Point, OH
  • NPI 1881186971
  Authorized official Same address or phone

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

{
    "created_epoch": "1605398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605398400000",
    "number": "1194327098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 E 45TH ST STE 234",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441271091",
            "telephone_number": "419-406-0067",
            "fax_number": "866-309-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 E 45TH ST STE 234",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441271091",
            "telephone_number": "419-406-0067",
            "fax_number": "866-309-3044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "613 Canyon Dr",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "458043308",
            "country_code": "US",
            "telephone_number": "419-406-0067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDERGENIX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-15",
        "last_updated": "2020-11-15",
        "certification_date": "2020-11-15",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-406-0067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, CNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providergenix Healthcare Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Nurse Practitioner in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Primary Care Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2020; 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.