Keith Aniel Russworm Jr., NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

A005484 Issued in AR

Practice address

1600 W 40TH Ave
Pine Bluff, AR 71603-6301

Phone

(870) 541-7100

NPI assigned

Jan 15, 2018

Sex

Male

Sole proprietor

No

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.

• Ouachita County Medical Center

  • Emergency Care Clinic/Center
  • Camden, AR
  • NPI 1346354826

  AR

  Medicare reassignment Care Compare group NPD
• Southeast Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • Pine Bluff, AR
  • NPI 1922475078

  AR, Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• WH Services Arkansas, LLC

  • Emergency Medicine Physician
  • Forrest City, AR
  • NPI 1952135949

  AR

  Medicare reassignment Care Compare group NPD
• Ouachita County Medical Center

  • Rural Acute Care Hospital
  • Camden, AR
  • NPI 1245284769
  Care Compare group NPD
• Arbor Hospice and Palliative Care, LLC

  • Community Based Hospice Care Agency
  • Camden, AR
  • NPI 1265471064
  Care Compare group
• Ouachita County Medical Center

  • Ambulance
  • Camden, AR
  • NPI 1891735494
  Care Compare group
• Ouachita County Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Camden, AR
  • NPI 1972543627
  Care Compare group
• Trinity Home Health of Southern Arkansas, LLC

  • Home Health Agency
  • Camden, AR
  • NPI 1306886080
  Care Compare group
• Southeast Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • Pine Bluff, AR
  • NPI 1467817411
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jefferson Hospital Association Inc

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Arkansas Emergency Physicians LLP 17 clinicians

WH Services Arkansas, LLC 22 clinicians

Ouachita County Medical Center 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071
• Ouachita County Medical Center Hospital, Camden, AR, CCN 040050

Medicare fee-for-service enrollment

Enrolled in AR

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

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 25, 2018.

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516838400000",
    "number": "1497263222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSWORM",
        "first_name": "KEITH",
        "middle_name": "ANIEL",
        "name_suffix": "Jr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-15",
        "last_updated": "2018-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A005484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori L Rotton, APRN
• Tawanna Rouse
• Pamela Rowland, RN,CDE
• Carla Royal
• Amber Russell, LPN
• Harry L. Ryburn, D.D.S.
• Nancy Elizabeth Ryburn, PH.D., M.A.
• Hamida Saba, MD
• Kearie Saine
• Shahidah Salaam, LMSW

• All providers in Pine Bluff, AR
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.
• 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.