Shane B Russell-Jenkins, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD2004-0132 Issued in NM

Practice address

2555 E Gila Ridge Rd
Yuma, AZ 85365-2240

Phone

(928) 317-9972

NPI assigned

Aug 31, 2006

Last updated

Sep 9, 2010By 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

Other identifiers 1

Other names 1

• Shane B Russell-Jenkins Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Counseling Associates Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Roswell, NM
  • NPI 1114979747
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283990400000",
    "number": "1508978750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 E GILA RIDGE RD",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853652240",
            "telephone_number": "928-317-9972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 E GILA RIDGE RD",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853652240",
            "telephone_number": "928-317-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL-JENKINS",
        "first_name": "SHANE",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "MD2004-0132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77456581",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANE",
            "last_name": "RUSSELL-JENKINS",
            "middle_name": "B",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alejandra Ruiz Pureco, SLPA
• Celena Ruiz, PA
• Susan Mary Rundle, FNP
• Rural Metro Fire Dept Inc
• Paige Elizabeth Ruscher, PA-C
• Nathan Russell
• Dawn Renee Ruttan
• Martha Ryan-Castro, IHP
• Savannah Ryken, DPT
• S.R. Shields, D.D.S.

• Psychiatry Physician in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Psychiatry Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; 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.