Individual provider Active NPI

Stephen K Russell, DDS

  • General Practice Dentistry
  • Kansas City, MO
National Provider Identifier
1477635076
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
MO14715 Issued in MO
Practice address
9501 North Oak
Suite 205
Kansas City, MO 64155
Phone
(816) 436-2242
Fax
(816) 436-5435
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X MO14715 MO Primary

Addresses

Primary practice location

9501 North Oak
Suite 205
Kansas City, MO 64155

Mailing address

9501 North Oak
Suite 205
Kansas City, MO 64155
Phone (816) 436-2242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170113000779 MO Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0840572517

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MO14715MOMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Designs LC Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477635076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9501 NORTH OAK",
            "address_2": "SUITE 205",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64155",
            "telephone_number": "816-436-2242",
            "fax_number": "816-436-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 NORTH OAK",
            "address_2": "SUITE 205",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64155",
            "telephone_number": "816-436-2242",
            "fax_number": "816-436-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "STEPHEN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "MO14715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.