Ty D Russell, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

15,726 Issued in AR

Practice address

207 Atlanta Street S.E.
Gravette, AR 72736

Phone

(479) 787-7555

Fax

(479) 787-7444

NPI assigned

Sep 13, 2010

Last updated

Sep 17, 2014By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Bailey Health Center, LLC

  dba Health Builders

  • Chiropractor
  • Gravette, AR
  • NPI 1376834382
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410912000000",
    "number": "1487961322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 ATLANTA STREET S.E.",
            "city": "GRAVETTE",
            "state": "AR",
            "postal_code": "72736",
            "telephone_number": "479-787-7555",
            "fax_number": "479-787-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 ATLANTA STREET S.E.",
            "city": "GRAVETTE",
            "state": "AR",
            "postal_code": "72736",
            "telephone_number": "479-787-7555",
            "fax_number": "479-787-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-13",
        "last_updated": "2014-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "15,726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Marcus Poemoceah, MD
• Karen I Privett
• Mylynda Privett
• Debbie Query, LM, CPM
• Christopher Ray Rouse
• Kenneth Jake Sample, MD
• Sgoh Acquisition Inc (Ozarks Community Hospital of Gravette)
• Sgoh Acquisition Inc (Ozarks Community Hospital of Gravette)
• Sgoh Acquisition Inc (Ozarks Community Hospital of Gravette)
• Marva Shockley

• Chiropractor in Gravette, AR
• Providers in Gravette, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.