Samara Deva Russell, APRN, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

26NJ0107800 Issued in NJ

Practice address

400 Valley Rd Ste 105
Mount Arlington, NJ 07856-2316

Phone

(973) 770-7101

Fax

(973) 770-7108

NPI assigned

Sep 7, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Advocare, LLC

  • Pediatrics Physician
  • Marlton, NJ
  • NPI 1770538696
  Medicare reassignment NPD
• Advocare , LLC

  • Internal Medicine Physician
  • Manahawkin, NJ
  • NPI 1912762162
  NPD

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

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1356622120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 KILVERT ST",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028861379",
            "telephone_number": "401-447-6090",
            "fax_number": "877-626-6891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 VALLEY RD STE 105",
            "city": "MOUNT ARLINGTON",
            "state": "NJ",
            "postal_code": "078562316",
            "telephone_number": "973-770-7101",
            "fax_number": "973-770-7108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Kilvert St",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028861379",
            "country_code": "US",
            "telephone_number": "401-447-6090",
            "fax_number": "877-626-6891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SAMARA",
        "middle_name": "DEVA",
        "name_prefix": "Mrs.",
        "credential": "APRN, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-07",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "004763",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "RI",
            "license": "CAPRN00529",
            "primary": false
        },
        {
            "code": "364SX0106X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Occupational Health",
            "state": "CT",
            "license": "4763",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ0107800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Redner
• Allison Reynolds, LCSW
• Richard D Riva DDS & Gerard a Begley DMD LLC
• Alena Rodriguez
• Liseth Stefanny Rodriguez, LSW
• Christine Sabo
• Satyam Pharmacy Inc
• Michael L Sawyer, PT
• Michael John Scarneo Jr., PT, DPT
• Brian Schwartz, MD

• Adult Health Nurse Practitioner in Mount Arlington, NJ
• Providers in Mount Arlington, NJ by specialty
• Adult Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.