NPIMap

Individual provider Active NPI

Bertram Royce Russell Jr., MD

  • Diagnostic Radiology Physician
  • West Chester, PA
National Provider Identifier
1386664407
Registry record updated Dec 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD020168E Issued in PA
Practice address
701 E Marshall St
West Chester, PA 19380-4412
Phone
(610) 431-5132
Fax
(610) 363-9892
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD020168E PA Primary

Addresses

Primary practice location

701 E Marshall St
West Chester, PA 19380-4412

Mailing address

416 Youngsford LN
Gladwyne, PA 19035-1609
Phone (610) 658-2244

Other identifiers 1

IdentifierTypeStateIssuer
000741496MedicaidPA

Other names 1

  • B. Royce Russell Jr. Other name

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD020168EPAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of the University of Pennsylvania Past Accepting new patients
Radiology Associates of Mansfield, Inc Diagnostic Radiology Past Accepting new patients
The Union Hospital Association Past Accepting new patients
Univ of Penn Community Radiology Diagnostic Radiology Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228867200000",
    "number": "1386664407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 YOUNGSFORD LN",
            "city": "GLADWYNE",
            "state": "PA",
            "postal_code": "190351609",
            "telephone_number": "610-658-2244",
            "fax_number": "610-658-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E MARSHALL ST",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193804412",
            "telephone_number": "610-431-5132",
            "fax_number": "610-363-9892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "BERTRAM",
        "middle_name": "ROYCE",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2008-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD020168E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000741496",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "B.",
            "last_name": "RUSSELL",
            "middle_name": "ROYCE",
            "suffix": "JR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; 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.