Individual provider Active NPI

Russell Noblett, M.D.

  • Internal Medicine Physician
  • Roanoke, VA
National Provider Identifier
1255386074
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101053399 Issued in VA
Practice address
4461 Starkey Road
Suite 201
Roanoke, VA 24018
Phone
(540) 345-4946
Fax
(540) 343-7693
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101053399 VA Primary

Addresses

Primary practice location

4461 Starkey Road
Suite 201
Roanoke, VA 24018

Mailing address

4461 Starkey Rd
Suite 201
Roanoke, VA 24018
Phone (540) 345-4946

Other identifiers 6

IdentifierTypeStateIssuer
140116OtherVAANTHEM
4601654OtherVACIGNA
7280194OtherVAAETNA
110212716OtherVARAILROAD MEDICARE
1255386074MedicaidVA
315994OtherVASOUTHERN HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101053399VAMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: rnoblett@pav.ssdirect.aprima.com

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1255386074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4461 STARKEY RD",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24018",
            "telephone_number": "540-345-4946",
            "fax_number": "540-982-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4461 STARKEY ROAD",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24018",
            "telephone_number": "540-345-4946",
            "fax_number": "540-343-7693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBLETT",
        "first_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101053399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "140116",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4601654",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7280194",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110212716",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255386074",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "315994",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.