Andrew Wray Russ, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA53942 Issued in CA

Practice address

124 E Olive Ave
Redlands, CA 92373-5250

Phone

(909) 798-9403

NPI assigned

Dec 15, 2016

Last updated

Dec 15, 2016By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• The Botox Spot Physician Assistant Corporation

  dba The Botox Spot

  • Medical Specialty Clinic/Center
  • Redlands, CA
  • NPI 1710756390
  NPD Authorized official

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

{
    "created_epoch": "1481760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481760000000",
    "number": "1457895054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 BELMONT CT",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923737118",
            "telephone_number": "909-644-6420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E OLIVE AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735250",
            "telephone_number": "909-798-9403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSS",
        "first_name": "ANDREW",
        "middle_name": "WRAY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-15",
        "last_updated": "2016-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA53942",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "01024357",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Berta Margarita Rubio, MD
• Monica Elise Ruby
• Horst R Rudrich, D.O.
• Christina Ruiz
• Cynthia E Ruiz, M.D.
• Russell Seheult, D.D.S., a Professional Corporation (Redlands Dental Surgery Center)
• Billy Allen Russell Jr.
• Charity Penaloza Russell, MD
• Judith Russell, LCSW
• Saliar T Rustem, M.D.

• Medical Physician Assistant in Redlands, CA
• Providers in Redlands, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.