Russell W Pellar, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

01029020A Issued in IN

Practice address

10110 Donald Powers Dr
Suite 202
Munster, IN 46321

Phone

(219) 922-0222

Fax

(219) 922-8899

NPI assigned

May 5, 2006

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Lake Surgical Associates, LLC

  • Surgery Physician
  • Munster, IN
  • NPI 1275673865
  NPD (past) Authorized official

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345161600000",
    "number": "1346298676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10110 DONALD POWERS DR",
            "address_2": "SUITE 202",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212915",
            "telephone_number": "219-922-0222",
            "fax_number": "219-922-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10110 DONALD POWERS DR",
            "address_2": "SUITE 202",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "46321",
            "telephone_number": "219-922-0222",
            "fax_number": "219-922-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLAR",
        "first_name": "RUSSELL",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2012-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01029020A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100200800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald P. Pavelka, M.D.
• Mary Pawlicki, PT
• Mariah T Payne, D.C.
• Richard J Peach, O.D.
• Katie Peksenak, PA-C
• Stephanie Gail Penacho, PMHNP
• Antoinette Perez, NP
• Michael Samuel Perez, D.D.S.
• Omar M Perez, M.D.
• Katie Persenaire

• Surgery Physician in Munster, IN
• Providers in Munster, IN by specialty
• Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.