Renee J Russell MD Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22021 Issued in OK

Legal business name

RENEE J RUSSELL MD INC

Practice address

900 E 13TH St
Suite 104
Grove, OK 74344-2975

Phone

(918) 786-3100

Fax

(918) 786-3108

NPI assigned

Jan 24, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Renee Jean Russell, M.D.NPI 1245286921

Title

Provider

Phone

(918) 786-3100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grand Lake Primary Care Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8425/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renee Jean Russell, MD

  • Family Medicine Physician
  • Grove, OK
  • NPI 1245286921
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478822400000",
    "number": "1316092182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 NEO LOOP",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743446046",
            "telephone_number": "918-786-3100",
            "fax_number": "918-786-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E 13TH ST",
            "address_2": "SUITE 104",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442975",
            "telephone_number": "918-786-3100",
            "fax_number": "918-786-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEE J RUSSELL MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2016-11-11",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "918-786-3100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "22021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100017290D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Lake Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jack Louis Rector, DPH
• W. Jay Rector II, M. ED
• Casey Lynn Reed
• Cheryl Jean Reed
• Regional Cardiology PA
• Renee J. Zarintash, M.D., P.L.L.C
• Respiratory Specialties
• Tamary Suzann Rhodes, LMT
• Destiny Rice
• Jennifer K Richard, BSN

• Family Medicine Physician in Grove, OK
• Providers in Grove, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.