Active NPI
Stephen Maurice Russell, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Bend, OR
National Provider Identifier
1376935528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- MD21866
- Practice address
- 3391 NW Panorama Dr
Bend, OR 97701-5461 - Phone
- (541) 693-4376
- NPI assigned
- Feb 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD21866 | OR | Primary |
Addresses
Primary practice location
3391 NW Panorama Dr
Bend, OR 97701-5461
Mailing address
3391 NW Panorama Dr
Bend, OR 97701-5461
Phone (541) 693-4376
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD21866 | OR | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1376935528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3391 NW PANORAMA DR",
"city": "BEND",
"state": "OR",
"postal_code": "977015461",
"telephone_number": "541-693-4376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3391 NW PANORAMA DR",
"city": "BEND",
"state": "OR",
"postal_code": "977015461",
"telephone_number": "541-693-4376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "STEPHEN",
"middle_name": "MAURICE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-25",
"last_updated": "2015-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "OR",
"license": "MD21866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.