Russell Glen Medders, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

29710 Issued in NC

Practice address

4600 Lake Boone Trail
Suite 100
Raleigh, NC 27607-7529

Phone

(919) 787-1374

Fax

(919) 571-8135

NPI assigned

May 3, 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 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gmedders@raleighcapitolent.emadirect.md
• Direct secure messaging: rmedders@raleighcapitolent.emadirect.md

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.

• Raleigh Capitol Ear, Nose, and Throat

  • Otolaryngology Physician
  • Raleigh, NC
  • NPI 1902170442
  Medicare reassignment NPD
• Capitol Ear, Nose & Throat

  • Otolaryngology/Facial Plastic Surgery Physician
  • Raleigh, NC
  • NPI 1477554327
  NPD (past)

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1376501049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 LAKE BOONE TRAIL",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077529",
            "telephone_number": "919-787-1374",
            "fax_number": "919-571-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 LAKE BOONE TRAIL",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077529",
            "telephone_number": "919-787-1374",
            "fax_number": "919-571-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDDERS",
        "first_name": "RUSSELL",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "29710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "040002669",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1050117",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8958402",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "58402",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "RMedders@raleighcapitolent.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Messages",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "messages",
            "address_1": "4600 Lake Boone Trail",
            "address_2": "Suite 100",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276077529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Med One Medical Group
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• Medassist, Inc.
• Miriam Medero-Eng, MD
• Medfirst, Inc
• Medi-Rides Transportation
• Medical Assign Professionals, LLC
• Medical Boss Transportation

• Otolaryngology Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Otolaryngology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.