Russell Alfaro

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Practice address

21806 103Rd Avenue CT E Ste 101
Graham, WA 98338-8115

Phone

(253) 780-6061

NPI assigned

Nov 26, 2021

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

Practice roles

Locations

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.

• Lifted Hypnosis LLC

  • Multi-Specialty Clinic/Center
  • Graham, WA
  • NPI 1437874443

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1637884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637884800000",
    "number": "1265199178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21806 103RD AVENUE CT E STE 101",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983388115",
            "telephone_number": "253-780-6061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21806 103RD AVENUE CT E STE 101",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983388115",
            "telephone_number": "253-780-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALFARO",
        "first_name": "RUSSELL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-26",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Active Wound Healing
• Egidio L Ade
• Nathan David Adelman, DPT
• Advanced Spinal Care, Inc
• Victoria M Alexander, CO7010475
• Sara Michele Allen, LMP
• Alliance Physical Therapy
• Karen Marie Anderson, LMP
• Tamara L Anderson
• Angela Erdahl, RN

• All providers in Graham, WA
• Multi-Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2021; 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.