NPIMap

Individual provider Active NPI

Andrew Russell, DO

  • Internal Medicine Physician
  • Rogers, AR
National Provider Identifier
1326509365
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-13608 Issued in AR
Practice address
2710 S Rife Medical LN
Rogers, AR 72758-1452
Phone
(479) 636-0200
Fax
(479) 986-3448
NPI assigned
Mar 30, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2022015511 MO
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X E-13608 AR Primary

Addresses

Primary practice location

2710 S Rife Medical LN
Rogers, AR 72758-1452

Mailing address

2710 S Rife Medical LN
Rogers, AR 72758-1452
Phone (479) 636-0200

Other practice location 1

4800 E Johnson Ave
Jonesboro, AR 72401-8413
Phone (573) 823-3412

Other practice location 2

100 Mercy Way
Joplin, MO 64804-4524
Phone (417) 556-3754

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210326000245 AR Practitioner - HospitalistPractitioner - Internal Medicine 1052648169 Reassigns benefits to 4 organizations
I20220819002310 MO Practitioner - Internal Medicine 1052648169 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Liberty Univ College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Joplin LLCGroup PAC ID 0547300196, 288 clinicians

Practice addresses (Care Compare)

100 Mercy Way
Mercy Clinic Joplin Hospitalists
Joplin, MO 64804-4524
Phone (417) 556-3754

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2022015511MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 1, 2023 Accepting new patients
Mercy Hospital Carthage CurrentSince Aug 1, 2024 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 1, 2023 Accepting new patients
Mercy Hospital Carthage CurrentSince Aug 1, 2024 Accepting new patients
Ies HSP Arkansas PLLC CurrentSince Jul 12, 2023 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Mercy Clinic Joplin LLC Internal Medicine CurrentSince Aug 22, 2022 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Mar 1, 2021 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Jul 1, 2023 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Mar 1, 2021 Accepting new patients
Mercy Hospital Joplin Past Accepting new patients

Locations

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

3873 N Parkview Dr
Fayetteville, AR 72703
Phone (479) 527-0050

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

2710 S Rife Medical Ln
Rogers, AR 72758
Phone (479) 338-8000

3116 Medical Park Dr
Carthage, MO 64836
Phone (417) 358-7574

94 Main St
Cassville, MO 65625
Phone (417) 782-7722

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

Organizations & group practices 12

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1553904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1326509365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 S RIFE MEDICAL LN",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-636-0200",
            "fax_number": "479-986-3448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 S RIFE MEDICAL LN",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-636-0200",
            "fax_number": "479-986-3448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 E Johnson Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724018413",
            "country_code": "US",
            "telephone_number": "573-823-3412",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Mercy Way",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648044524",
            "country_code": "US",
            "telephone_number": "417-556-3754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ANDREW",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-30",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2022015511",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-13608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

Verify at the official NPI Registry.