Individual provider Active NPI

Madison Russell

  • Family Nurse Practitioner
  • Pocatello, ID
National Provider Identifier
1376480939
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F04260453 Issued in ID
Practice address
777 Hospital Way
Pocatello, ID 83201-5175
Phone
(208) 239-1801
NPI assigned
May 1, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F04260453 ID Primary

Addresses

Primary practice location

777 Hospital Way
Pocatello, ID 83201-5175

Mailing address

231 Ravine Dr
Pocatello, ID 83204-4026
Phone (360) 670-9047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2026
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1000

Hospital & facility affiliations

  • Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F04260453IDMDFamily Nurse Practitioner

Organizations & group practices 1

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 2

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": "1777593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777593600000",
    "number": "1376480939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 RAVINE DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832044026",
            "telephone_number": "360-670-9047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MADISON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-01",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "F04260453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.