Elizabeth B Russell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1862 Issued in MA

Practice address

450 Brookline Ave
Boston, MA 02215

Phone

(404) 735-6905

NPI assigned

Nov 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Elizabeth Breckheimer Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russell.elizabeth.bwh@direct.partners.masshiway.net

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.

• Dana-Farber Cancer Institute, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1851333686
  Medicare reassignment NPD
• Dana-Farber Cancer Institute, Inc.

  • Special Hospital
  • Boston, MA
  • NPI 1346433257
  NPD
• Dana-Farber Cancer Institute, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Chestnut Hill, MA
  • NPI 1497429237
  NPD
• Cherokee Emergency Services, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Atlanta, GA
  • NPI 1992754717
  NPD (past)

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1457426702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155450",
            "telephone_number": "404-735-6905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02215",
            "telephone_number": "404-735-6905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "81 Highland Ave",
            "address_2": "Emergency Services",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "MA",
            "postal_code": "019702714",
            "country_code": "US",
            "telephone_number": "978-354-3517",
            "fax_number": "978-740-4731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ELIZABETH",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "04709",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA1862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163604725B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "BRECKHEIMER",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eleanor Russell-Goldman, MD, PHD
• Anthony Henryk Russell, MD
• Brian Michael Russell
• Christopher G Russell, PA-C
• Christopher W Russell, M.D.
• Emily Russell, PA-C
• Evan Russell, NP
• Ezekiel Elijah Russell
• Grace Russell
• Hannah Russell, NP

• Medical Physician Assistant in Boston, MA
• Providers in Boston, MA by specialty
• Medical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; 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.