Russel Grover Ladwig, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17196 Issued in CA

Practice address

9300 Valley Childrens PL
Madera, CA 93636-8762

Phone

(559) 353-3000

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: rladwig13935@valleychildrens-prd.direct-ci.com

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.

• River City Medical Group, Inc.

  • Family Medicine Physician
  • Sacramento, CA
  • NPI 1083722516
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1235163858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 E PINTAIL CIRCLE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937201266",
            "telephone_number": "599-433-9282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368762",
            "telephone_number": "559-353-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LADWIG",
        "first_name": "RUSSEL",
        "middle_name": "GROVER",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ji Yeon Kwon, NP
• Shannel Kwon
• Kyu Yon Lee
• L.H. Althuijzen LLC.
• Michelle Monette Ladwig, PA
• Lags Spine and Sportscare Medical Centers, Inc.
• Krista Lynn Shement Lai
• Nhu Thi Quynh Lai
• Ravendeep Lally, PPS
• Sophie Lanciers, MD

• Physician Assistant in Madera, CA
• Providers in Madera, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.