Jonathan Forrest Russell, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

161337 Issued in OR

Practice address

671 SW Main St
Winston, OR 97496-6571

Phone

(541) 492-4550

Fax

(541) 679-2005

NPI assigned

Oct 17, 2007

Last updated

Mar 5, 2025By the provider in NPPES

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 7

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

AdaptGroup PAC ID 4587662887, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Care Home health agency, Roseburg, OR, CCN 387311
• Mercy Medical Center Hospital, Roseburg, OR, CCN 380027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jrussell324524@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adapt

  • Addiction (Substance Use Disorder) Counselor
  • Roseburg, OR
  • NPI 1720010549
  Medicare reassignment Care Compare group
• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1184350811
  NPD
• Adapt

  dba Adapt Integrated Health Care

  • Federally Qualified Health Center (FQHC)
  • Bandon, OR
  • NPI 1194529289
  NPD
• Adapt

  dba SouthRiver Community Health Center

  • Family Medicine Physician
  • Winston, OR
  • NPI 1528585783
  NPD (past)
• Adapt

  dba SouthRiver Medical Clinic aka: SouthRiver Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Winston, OR
  • NPI 1912061755
  NPD (past)
• Sun Life Family Health Center, Inc.

  dba Sun Life Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Eloy, AZ
  • NPI 1588876429
  NPD (past)
• Sun Life Family Health Center, Inc.

  dba Sun Life Family Health Center-Florence

  • Federally Qualified Health Center (FQHC)
  • Florence, AZ
  • NPI 1902278252
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys Oregon, L.L.C.

  dba Amedisys Home Health Care

  • Home Health Agency
  • Roseburg, OR
  • NPI 1093908725
  Care Compare affiliation
• Commonspirit Oregon

  dba CHI Mercy Medical Center

  • General Acute Care Hospital
  • Roseburg, OR
  • NPI 1477590198
  Care Compare affiliation

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1396934196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "671 SW MAIN ST",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "974966571",
            "telephone_number": "541-492-4550",
            "fax_number": "541-492-4553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 SW MAIN ST",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "974966571",
            "telephone_number": "541-492-4550",
            "fax_number": "541-679-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JONATHAN",
        "middle_name": "FORREST",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "161337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZFQ31815",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "03-1820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZFQ31820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z139132",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "03-1815",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364775",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z132429",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Myers, DDS
• Sara Ann Myers, PHARMD
• Oregon Community Dental Care
• Emily Ann Robertson, RDH
• Ronald F. Tribble, DMD, PC
• Second Wind Mental Health Clinic
• Michael Wayne Smith- Fernandez, LCSW
• Pazely Rachelle Spencer, PMHNP-BC
• Stacy J Nielsen, LCSW, LLC
• Coreen Stansfield

• Physician Assistant in Winston, OR
• Providers in Winston, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.