Mark Duane Russell, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

3950 Hollywood Rd Ste 140
Saint Joseph, MI 49085-9151

Phone

(269) 556-7150

NPI assigned

Jul 21, 2006

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

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.

• Lakeland Hospitals at Niles and St Joseph, Inc

  • Community Health Clinic/Center
  • Saint Joseph, MI
  • NPI 1184513731
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306867049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4858 SADLER DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490988703",
            "telephone_number": "269-463-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 HOLLYWOOD RD STE 140",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859151",
            "telephone_number": "269-556-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARK",
        "middle_name": "DUANE",
        "credential": "ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marek Rozynek, MD
• RPG Inc
• Jonathan Rubin, MD
• Deanna Margaret Rucano, NP
• Margo Christine Runkle, JD, MA
• Salenna Russello, TLLP
• RX Optical Laboratories, Inc.
• Shannon Ryan Whitman, PHYSICAL THERAPIST
• Katlyn Sacco
• Yamann Sahlool

• Athletic Trainer in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.