Individual provider Active NPI

Raymond S Russell, M.D.

  • Urology Physician
  • Miamisburg, OH
National Provider Identifier
1447206933
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
35073039 Issued in OH
Practice address
4000 Miamisburg Centerville Rd
Suite 405
Miamisburg, OH 45342-7615
Phone
(937) 560-2011
Fax
(937) 560-2012
NPI assigned
May 26, 2006
Last updated
Nov 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 35073039 OH Primary

Addresses

Primary practice location

4000 Miamisburg Centerville Rd
Suite 405
Miamisburg, OH 45342-7615

Mailing address

4000 Miamisburg Centerville Rd Ste 207
Miamisburg, OH 45342-3674
Phone (937) 560-2011

Other identifiers 1

IdentifierTypeStateIssuer
2169380MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rrussell189306@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20041202000849 OH Practitioner - Urology 6002717618 Reassigns benefits to 2 organizations
I20240926003673 IN Practitioner - Urology 6002717618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

4000 Miamisburg Centerville Rd
Suite 450
Miamisburg, OH 45342-3908
Phone (937) 560-2011

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.8 of 100Reported as group
Quality
73.21
Promoting interoperability
100
Improvement activities
40
Cost
76.12

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35073039OHMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Golden Medical, LLC CurrentSince Apr 24, 2006 Accepting new patients
Reid Physician Associates, Inc CurrentSince Aug 31, 2024 Accepting new patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients
Reid Physician Associates, Inc. CurrentSince Aug 31, 2024 Accepting new patients
Lincoln Park Surgery Center PastSince Jan 16, 2004 Accepting new patients

Locations

1050 Reid Pkwy
Ste 325
Richmond, IN 47374
Phone (765) 935-8905

1100 Reid Pkwy
Richmond, IN 47374
Phone (765) 983-3000

425 W Grand Ave
Ste 1006
Dayton, OH 45405
Phone (937) 226-7871

3533 Southern Blvd
Ste 5200
Kettering, OH 45429
Phone (937) 395-8002

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

4000 Miamisburg Centerville Rd
Ste 405
Miamisburg, OH 45342
Phone (937) 439-3600

4000 Miamisburg Centerville Rd
Ste 435
Miamisburg, OH 45342
Phone (937) 384-4511

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

4000 Miamisburg Centerville Rd
Ste 207
Miamisburg, OH 45342
Phone (937) 560-2011

4000 Miamisburg Centerville Rd
Ste 450
Miamisburg, OH 45342
Phone (937) 439-3600

Interoperability endpoints

  • Direct secure messaging: rrussell484095@reidhealth.direct-ci.com

Organizations & group practices 5

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 5

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": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1447206933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD STE 207",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423674",
            "telephone_number": "937-560-2011",
            "fax_number": "937-560-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MIAMISBURG CENTERVILLE RD",
            "address_2": "SUITE 405",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453427615",
            "telephone_number": "937-560-2011",
            "fax_number": "937-560-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "RAYMOND",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35073039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2169380",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rrussell189306@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd",
            "address_2": "Suite 405",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd",
            "address_2": "Suite 405",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453427615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Miamisburg, OH

Sources for this page

Verify at the official NPI Registry.