Active NPI
Samuel David Russ, MD
- Orthopaedic Surgery Physician
- Woodbury, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 69423
- Practice address
- 2090 Woodwinds Dr Ste 200
Woodbury, MN 55125-2522 - Phone
- (651) 968-5201
- NPI assigned
- Apr 24, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | MD23695 | ME | |
| Orthopaedic Surgery Physician | 207X00000X | 69423 | MN | Primary |
Addresses
Primary practice location
2090 Woodwinds Dr Ste 200
Woodbury, MN 55125-2522
Mailing address
710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Orthopedic Surgery
- Education
- University of Minnesota Medical School, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2090 Woodwinds Dr
Woodbury, MN 55125-2522
Phone (651) 968-5201
319 S Main St
River Falls, WI 54022-2452
Phone (651) 968-5201
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69423 | MN | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Orthopedics LTD | Orthopaedic Surgery | Current | Accepting new patients |
| Summit Orthopedics, LTD | Orthopaedic Surgery | Current | Accepting new patients |
| Summit Orthopedics, LTD. | Current | Accepting new patients | |
| Summit Orthopedics LTD | Current | Accepting new patients | |
| Ilbnc, P.a. | Past | Accepting new patients |
Locations
2450 Riverside Ave
#R200
Minneapolis, MN 55454
Phone (612) 273-1177
1661 Saint Anthony Ave
Saint Paul, MN 55104
Phone (651) 968-5300
2620 Eagan Woods Dr
Saint Paul, MN 55121
Phone (651) 968-5142
710 Commerce Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5042
2090 Woodwinds Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5600
2090 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 968-5801
319 S Main St
River Falls, WI 54022
Phone (715) 425-6701
Interoperability endpoints
- samuelruss@sol.allscriptsdirect.net
Organizations & group practices 5
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.
-
- Orthopaedic Surgery Physician
- Eden Prairie, MN
- NPI 1417639626
-
dba Minnesota Occupational Health
- Occupational Medicine Clinic/Center
- Saint Paul, MN
- NPI 1275684128
-
dba Institute for Low Back & Neck Care
- Orthopaedic Surgery of the Spine Physician
- Bloomington, MN
- NPI 1023001815
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Fairview Woodwinds Hospital
- General Acute Care Hospital
- Woodbury, MN
- NPI 1356309322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627862400000",
"number": "1518354828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 COMMERCE DR STE 200",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551254925",
"telephone_number": "651-968-5200",
"fax_number": "651-968-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2090 WOODWINDS DR STE 200",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252522",
"telephone_number": "651-968-5201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSS",
"first_name": "SAMUEL",
"middle_name": "DAVID",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-24",
"last_updated": "2021-08-02",
"certification_date": "2021-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "ME",
"license": "MD23695",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "MN",
"license": "69423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; 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.