NPIMap

Individual provider Active NPI

Russell G. Forsberg, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1407039910
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3769 Issued in AZ
Practice address
9305 W Thomas Rd
Suite 380
Phoenix, AZ 85037-3328
Phone
(623) 327-4144
NPI assigned
Dec 7, 2007
Last updated
Mar 17, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3769 AZ Primary

Addresses

Primary practice location

9305 W Thomas Rd
Suite 380
Phoenix, AZ 85037-3328

Mailing address

9305 W Thomas Rd
Suite 380
Phoenix, AZ 85037-3328

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071231000085 AZ Practitioner - Physician Assistant 7810077039 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siren Medical PCGroup PAC ID 6608298419, 19 clinicians

Practice addresses (Care Compare)

14631 N Cave Creed Rd
Suite 104
Phoenix, AZ 85022-4100
Phone (602) 715-2568

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.24 of 100Reported as group
Quality
66.21
Improvement activities
40
Cost
66.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3769AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
LHCG Lxxvii, LLC Past Accepting new patients
Youngtown Health, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: russell.forsberg@57560418353156.direct.elationemr.com

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1407039910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9305 W THOMAS RD",
            "address_2": "SUITE 380",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850373328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9305 W THOMAS RD",
            "address_2": "SUITE 380",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850373328",
            "telephone_number": "623-327-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSBERG",
        "first_name": "RUSSELL",
        "middle_name": "G.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-07",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.