Active NPI
Russell P Carter Jr., MD
- Internal Medicine Physician
- Manteca, CA
National Provider Identifier
1528049988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G35573
- Practice address
- 200 Cottage Ave
Suite 201
Manteca, CA 95336 - Phone
- (209) 239-4554
- Fax
- (209) 239-4011
- NPI assigned
- Nov 10, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G35573 | CA | Primary |
Addresses
Primary practice location
200 Cottage Ave
Suite 201
Manteca, CA 95336
Mailing address
200 Cottage Ave
Suite 201
Manteca, CA 95336
Phone (209) 239-4554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G355730 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G35573 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193270400000",
"number": "1528049988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 COTTAGE AVE",
"address_2": "SUITE 201",
"city": "MANTECA",
"state": "CA",
"postal_code": "95336",
"telephone_number": "209-239-4554",
"fax_number": "209-239-4011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 COTTAGE AVE",
"address_2": "SUITE 201",
"city": "MANTECA",
"state": "CA",
"postal_code": "95336",
"telephone_number": "209-239-4554",
"fax_number": "209-239-4011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARTER",
"first_name": "RUSSELL",
"middle_name": "P",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2007-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G35573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G355730",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manteca, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.