Brent Charles Russell, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

50-00-0863 Issued in OH

Practice address

43145 Schoenherr Rd
Sterling Heights, MI 48313-1955

Phone

(589) 997-5048

Fax

(589) 997-5049

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255412318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12685 HIGHLAND RD",
            "city": "HARTLAND",
            "state": "MI",
            "postal_code": "483532933",
            "telephone_number": "419-865-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43145 SCHOENHERR RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483131955",
            "telephone_number": "589-997-5048",
            "fax_number": "589-997-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "BRENT",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "P.A.-C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601002647",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50-00-0863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE TO PRESCRIBE",
            "identifier": "55.000448",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAIN MANAGEMENT",
            "identifier": "5601002647",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Ruhlman, RPH
• Heather M Ruppel, MD
• Destiny S'Mone Rushing
• Cody Rushton
• Russ J Ortisi DDS & Anthony C Abate DDS PLLC
• Erin Russell, DNP
• Susan Marie Russo
• Connor Troy Rutkowski
• Nina Marie Rutkowski, M.ED, BCBA, LBA
• Charity Rutter

• Medical Physician Assistant in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.