John Kenneth Russell, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY4430 Issued in CA

Practice address

1945 Palo Verde Ave
Suite 202
Long Beach, CA 90815-3443

Phone

(562) 799-3333

Fax

(562) 799-3355

NPI assigned

Oct 5, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• John K. Russell, PH.D. a Psychological Corporation

  • Addiction (Substance Use Disorder) Psychologist
  • Long Beach, CA
  • NPI 1851711881
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397692800000",
    "number": "1407843295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 PALO VERDE AVE",
            "address_2": "SUITE 202",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153443",
            "telephone_number": "562-799-3333",
            "fax_number": "562-799-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 PALO VERDE AVE",
            "address_2": "SUITE 202",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153443",
            "telephone_number": "562-799-3333",
            "fax_number": "562-799-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JOHN",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2014-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY4430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "95-3278711",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Giovanna Russ, LSW
• Olivia Russak, AMFT
• Bonita Russell
• Chloe Russell, PSY.D.
• J. Christopher Russell, DDS
• Judith Russell, MFT
• Laura A. Russell, M.D.
• Robb Russell, D.C.
• Terry Russell
• Thomas Russell II

• Clinical Psychologist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; 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.