NPIMap

Organization Active NPI

Dr Alan Russell PLC

  • Dentist
  • Minneapolis, MN
National Provider Identifier
1194997783
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
09480 Issued in MN
Legal business name
DR ALAN RUSSELL PLC
Practice address
2010 27TH Ave S
Minneapolis, MN 55406-1108
Phone
(612) 336-8478
NPI assigned
Mar 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Mrs. Kathy Hubred, CRDA
Title
Dental Assistant
Phone
(612) 336-8478

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 09480 MN Primary

Addresses

Primary practice location

2010 27TH Ave S
Minneapolis, MN 55406-1108

Mailing address

2010 27TH Ave S
Minneapolis, MN 55406-1108
Phone (612) 336-8478

Other identifiers 3

IdentifierTypeStateIssuer
160213600MedicaidMN
13D69RUOtherMNBLUE CROSS BLUE SHIELD
710609OtherMNUNITED OF CONCORDIA

National Provider Directory

National Provider Directory

Locations

2010 27th Ave S
Minneapolis, MN 55406
Phone (612) 336-8478

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1194997783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 27TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061108",
            "telephone_number": "612-336-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 27TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061108",
            "telephone_number": "612-336-8478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ALAN RUSSELL PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "HUBRED",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "DENTAL ASSISTANT",
        "authorized_official_telephone_number": "612-336-8478",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRDA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "09480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160213600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "13D69RU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED OF CONCORDIA",
            "identifier": "710609",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.