Matthew Craig Russell, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

A123886 Issued in CA

Practice address

Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134-0001

Phone

(619) 532-7504

NPI assigned

Aug 15, 2011

Last updated

Mar 30, 2023By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1313366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1427337914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NAVAL MEDICAL CENTER SAN DIEGO",
            "address_2": "34800 BOB WILSON DRIVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921340001",
            "telephone_number": "619-532-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAL MEDICAL CENTER SAN DIEGO",
            "address_2": "34800 BOB WILSON DRIVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921340001",
            "telephone_number": "619-532-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MATTHEW",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-15",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "123886",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "A123886",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A123886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin L. Russell, MD, MTM&H
• Kim Koehler Russell, OTR/L
• Laura Russell, LCSW
• Marie Russell, RN, MN, C-ANP
• Mary J Russell, PHYSICAL THERAPIST
• Natasha Coriell Russell
• Ondrea Necole Russell
• Rebecca Jean Russell, LMFT
• Sabrina Kristina Russell
• Samuel Peter Russell, MD

• Cardiovascular Disease Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.