Bryan Clint Russell

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

PT295117 Issued in CA

Practice address

160 C Ave
Coronado, CA 92118-1420

Phone

(619) 319-5992

NPI assigned

Jan 15, 2019

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

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

One Life Physical Therapy IncGroup PAC ID 1759811946, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• One Life Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Coronado, CA
  • NPI 1144851361
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1407320260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6621 ARCHWOOD AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921202401",
            "telephone_number": "619-319-5992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 C AVE",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921181420",
            "telephone_number": "619-319-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "BRYAN",
        "middle_name": "CLINT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-15",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "PT295117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael T Ricciardi, DO
• Richard F Prince M D Inc
• Neal Patrick Ridge, D.O.
• Brian Patrick Riley, SFIDC
• Nathaniel Christian Romero
• Jason Andrew Russell, PHD,DRBA, MLS,MBA
• David S Rutgard, DDS
• Elissa Salona, PT
• San Diego Diagnostic Radiology Medical Group Inc
• Lourdes Irina Sanchez

• Physical Medicine & Rehabilitation Physician in Coronado, CA
• Providers in Coronado, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.