Scott Kevin Russell, M.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT23597 Issued in CA

Practice address

312 W J St
Los Banos, CA 93635-4073

Phone

(209) 827-6178

Fax

(209) 827-6179

NPI assigned

Aug 26, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sport and Rehab Physical Therapy IncorporatedGroup PAC ID 0042350357, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Sport & Rehab Physical Therapy Incorporated

  • Physical Therapy Clinic/Center
  • Los Banos, CA
  • NPI 1558512327
  Medicare reassignment Care Compare group NPD Authorized official
• Central Valley Cardiovascular Medical Group, Inc

  • Medical Specialty Clinic/Center
  • Turlock, CA
  • NPI 1962750224
  NPD (past)

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

{
    "created_epoch": "1156550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1285742742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 W J ST",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936354069",
            "telephone_number": "209-827-6178",
            "fax_number": "209-827-6179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W J ST",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936354073",
            "telephone_number": "209-827-6178",
            "fax_number": "209-827-6179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SCOTT",
        "middle_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-26",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT23597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0235970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melisa Lauren Rotondi, FNP
• Lorena Rubio Trejo
• Rosamaria Elvara Rucobo
• Maria Jose Ruiz Ruiz Villa
• Stephanie Ruiz
• Susanna Russell, MPT
• Patricia Ruvalcaba - Gomez
• Lennen Ruvalcaba-Jimenez
• Doha Saeb
• Ghassan Saeb, M.D.

• Physical Therapist in Los Banos, CA
• Providers in Los Banos, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.