Carol D Russell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

LL861 Issued in FL

Practice address

Space Coast Volunteers in Medicine
2555 Judge Fran Jamieson Way
Viera, FL 32940

Phone

(321) 639-5813

Fax

(321) 637-7312

NPI assigned

Sep 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: carol.russell.1@17680.direct.athenahealth.com

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1336134865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 JUDGE FRAN JAMIESON WAY",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329405998",
            "telephone_number": "321-639-5813",
            "fax_number": "321-637-7312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SPACE COAST VOLUNTEERS IN MEDICINE",
            "address_2": "2555 JUDGE FRAN JAMIESON WAY",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "32940",
            "telephone_number": "321-639-5813",
            "fax_number": "321-637-7312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CAROL",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-12",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA2709",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2709",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "LL861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aurora Josefina Rocha
• Roger E Bassin MD PA
• Emilio Miguel Roig, M.D.
• Theresa Renee Rucker, PA
• Troy Lee Rush, MHA, PT
• Austin Ryan, H.A.S,H.I.S
• Stephen H Ryemon, DPM
• Sandra Teuber
• Darla Ann Sansom
• Rebbie L Santos, RPH

• Medical Physician Assistant in Viera, FL
• Providers in Viera, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.