Mary Eileen Kumah Russell, ACNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

228209 Issued in AZ

Practice address

625 N 6TH St
Phoenix, AZ 85004-2155

Phone

(602) 406-8222

Fax

(602) 406-7811

NPI assigned

Jun 26, 2019

Sex

Female

Sole proprietor

Yes

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 AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.russell.1@22854.direct.athenahealth.com

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.

• Monogram Health Professional Services PC

  • Nephrology Physician
  • Brentwood, TN
  • NPI 1952917122

  AZ, Nurse Practitioner

  Medicare reassignment NPD
• Monogram Health Professional Services PC

  • Nephrology Physician
  • Brentwood, TN
  • NPI 1134739089

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1417518747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 N 6TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850042155",
            "telephone_number": "602-406-8222",
            "fax_number": "602-406-7811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7330 N 99th Ave Ste 300350",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853073015",
            "country_code": "US",
            "telephone_number": "602-406-0220",
            "fax_number": "602-406-0242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARY",
        "middle_name": "EILEEN KUMAH",
        "credential": "ACNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "228209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary D. Russell, P.A.-C
• James Craig Russell, M.D.
• Kadeazana Russell
• Kelly Yvette Russell, MD
• Larry Doby Russell, D.D.S.
• Patricia Russell
• Janet M Russenberger, OT
• Daniela Cotrim Russi, M.D.
• Aubriana K Russo, RBT
• Cara Anne Russo, PHARMD, RPH

• Gerontology Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.