Mandy R Russell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004360 Issued in MI

Practice address

650 Linden St
Suite 5
Big Rapids, MI 49307-1879

Phone

(231) 796-0010

Fax

(231) 796-2496

NPI assigned

Jan 31, 2007

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Signature Eye Care Inc

  • Optometrist
  • Belmont, MI
  • NPI 1508248071
  Medicare reassignment NPD Authorized official
• Rapids Ophthalmology, PC

  • Ophthalmology Physician
  • Big Rapids, MI
  • NPI 1235230350
  Medicare reassignment
• Fowle Eyecare Associates PLC

  • Optometrist
  • Rockford, MI
  • NPI 1780888081
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305244800000",
    "number": "1316084965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20665 BLUE FOX WAY",
            "city": "HOWARD CITY",
            "state": "MI",
            "postal_code": "49329",
            "telephone_number": "231-340-0112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 LINDEN ST",
            "address_2": "SUITE 5",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493071879",
            "telephone_number": "231-796-0010",
            "fax_number": "231-796-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MANDY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2011-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0E40038",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG0293",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Ann Ruelle, LMSW
• Thomas James Rundquist, M.A. L.P.C.
• Stephen Brian Rupp, MD
• Russell Rehabilitation Services LLC
• Jonathan Michael Russell, PA-C
• Tyler Micheal Ryan
• Tracy Helen Sackett-Foster, P.A.C.
• Komal Saini
• Troy Edward Salinas, PA
• Samaritan Health Care, PC

• Optometrist in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; 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.
• 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.