Kimberly Russell, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

269874 Issued in MA

Practice address

35 Pearl St Ste 100
Brockton, MA 02301-2866

Phone

(508) 588-8034

Fax

(508) 588-5969

NPI assigned

Apr 19, 2012

Last updated

Apr 17, 2018By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

Boston University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

ENT Specialists, IncGroup PAC ID 0648353888, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Brown University Health Morton Hospital Hospital, Taunton, MA, CCN 220073
• Sturdy Memorial Hospital Hospital, Attleboro, MA, CCN 220008
• Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074
• Milford Regional Medical Center Hospital, Milford, MA, CCN 220090
• Brigham and Women's Hospital Hospital, Boston, MA, CCN 220110

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HFADAA
• Direct secure messaging: krussell8438@direct.bmc.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• ENT Specialists, Inc

  • Otolaryngology Physician
  • Brockton, MA
  • NPI 1548319809
  Medicare reassignment Care Compare group NPD
• ENT Norwood LLC

  • Otolaryngology Physician
  • Norwood, MA
  • NPI 1265749907
  Medicare reassignment NPD
• Milford Regional Physician Group, Inc.

  • Internal Medicine Physician
  • Milford, MA
  • NPI 1902856024
  Medicare reassignment NPD
• Milford Regional Physician Group, Inc.

  dba Sports Medicine & Wellness in Medway

  • Sports Medicine (Family Medicine) Physician
  • Medway, MA
  • NPI 1508681321
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Brigham & Womens Hospital, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1790717650
  Care Compare affiliation
• Lifespan of Massachusetts - Taunton Inc

  • General Acute Care Hospital
  • Taunton, MA
  • NPI 1609603877
  Care Compare affiliation
• Southcoast Hospitals Group, Inc

  dba Tobey Hospital

  • General Acute Care Hospital
  • Wareham, MA
  • NPI 1922024835
  Care Compare affiliation
• Sturdy Memorial Hospital Inc

  • General Acute Care Hospital
  • Attleboro, MA
  • NPI 1730106162
  Care Compare affiliation
• Umass Memorial Health-Milford Regional Medical Center Inc

  • General Acute Care Hospital
  • Milford, MA
  • NPI 1477527497
  Care Compare affiliation

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

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523923200000",
    "number": "1326305905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 PEARL ST",
            "address_2": "STE 100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012866",
            "telephone_number": "508-588-8034",
            "fax_number": "508-588-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 PEARL ST STE 100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012866",
            "telephone_number": "508-588-8034",
            "fax_number": "508-588-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KIMBERLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-19",
        "last_updated": "2018-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MA",
            "license": "269874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110102733A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vernice Jadine Brodit Ruiz, M.ED.
• Vida Mia Ruiz, CNM
• Debra Rushton-Ellis, PAC
• Brenda Nunes Ruskey, NP
• Hannah Russell
• Andrea Russo
• Kristina Lea Russo, M.A. L.M.H.C.
• Nancey T Russo, DO
• Joanna Ryan Laidley
• Bridget L Ryan

• Otolaryngology Physician in Brockton, MA
• Providers in Brockton, MA by specialty
• Otolaryngology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.