Active NPI
James Russell Logan, M.D.
- Pediatrics Physician
- Paradise, CA
National Provider Identifier
1477584001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G72586
- Practice address
- 6470 Pentz Rd
Suite a
Paradise, CA 95969 - Phone
- (530) 872-6655
- Fax
- (530) 872-6653
- NPI assigned
- Jul 5, 2006
- Last updated
- Apr 17, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G72586 | CA | Primary |
Addresses
Primary practice location
6470 Pentz Rd
Suite a
Paradise, CA 95969
Mailing address
6470 Pentz Rd
Suite a
Paradise, CA 95969
Phone (530) 872-6655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ01920Z | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130910000968 | CA | Order and Referring Only - Pediatric Medicine | 0446331649 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paradise Medical Group, Inc. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- james.logan.1@10649.direct.athenahealth.com
- jlogan15328@enloedirect.org
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366156800000",
"number": "1477584001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6470 PENTZ RD",
"address_2": "SUITE A",
"city": "PARADISE",
"state": "CA",
"postal_code": "95969",
"telephone_number": "530-872-6655",
"fax_number": "530-872-6653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6470 PENTZ RD",
"address_2": "SUITE A",
"city": "PARADISE",
"state": "CA",
"postal_code": "95969",
"telephone_number": "530-872-6655",
"fax_number": "530-872-6653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "JAMES",
"middle_name": "RUSSELL",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2013-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G72586",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ01920Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paradise, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.