Individual provider Active NPI

Tiffany Milan Russell, D.C.

  • Chiropractor
  • Waynesboro, PA
National Provider Identifier
1245532944
Registry record updated Jun 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC010340 Issued in PA
Practice address
12080 Skyhawk Dr
Unit B
Waynesboro, PA 17268-8305
Phone
(717) 749-7111
Fax
(717) 749-7113
NPI assigned
Dec 1, 2010
Last updated
Jun 17, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC010340 PA Primary

Addresses

Primary practice location

12080 Skyhawk Dr
Unit B
Waynesboro, PA 17268-8305

Mailing address

12080 Skyhawk Dr
Unit B
Waynesboro, PA 17268-8305
Phone (717) 749-7111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120823000412 PA Practitioner - Chiropractic 3870740004 Practice locations: Waynesboro, PA
I20150814013538 PA Practitioner - Chiropractic 3870740004 Practice locations: Waynesboro, PA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12080 Skyhawk Dr
Unit B
Waynesboro, PA 17268-8305

12080 Skyhawk Dr B
Waynesboro, PA 17268-8305
Phone (717) 749-7111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC010340PAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Herman Chiropractic Center, Inc. Chiropractor Past Accepting new patients
The Chiropractic Edge Chiropractor PastSince May 31, 2015 Accepting new patients
Kayce Inc Chiropractor Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434499200000",
    "number": "1245532944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12080 SKYHAWK DR",
            "address_2": "UNIT B",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172688305",
            "telephone_number": "717-749-7111",
            "fax_number": "717-749-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12080 SKYHAWK DR",
            "address_2": "UNIT B",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172688305",
            "telephone_number": "717-749-7111",
            "fax_number": "717-749-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TIFFANY",
        "middle_name": "MILAN",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-01",
        "last_updated": "2015-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC010340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.