Nicholas Andrew Russell, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10340 Issued in LA

Practice address

1450 Claiborne Ave
Shreveport, LA 71103-4204

Phone

(318) 813-2970

Fax

(318) 813-2981

NPI assigned

Aug 19, 2019

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

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lsuhsc-S School of Allied HealthGroup PAC ID 0840669123, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Lsuhsc-S School of Allied Health

  • Multi-Specialty Clinic/Center
  • Shreveport, LA
  • NPI 1144265976

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Brewer Physical Therapy & Associates LLC

  • Physical Therapy Clinic/Center
  • Shreveport, LA
  • NPI 1477709681
  Medicare reassignment NPD
• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222
  Medicare reassignment NPD
• Select Physical Therapy Texas Limited Partnership

  • Physical Therapy Clinic/Center
  • Houston, TX
  • NPI 1356304323
  NPD (past)

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

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1548817273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-813-2962",
            "fax_number": "318-813-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CLAIBORNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034204",
            "telephone_number": "318-813-2970",
            "fax_number": "318-813-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "NICHOLAS",
        "middle_name": "ANDREW",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-19",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "10340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174173",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Russell
• Kirsten McGee Russell, MCD, CCC-SLP
• Lawonda 71118 Russell
• Lekisha Russell, LPN
• Natalee Russell, PLPC
• Tyler Russell
• Amanda Calloway Rutherford, PA-C
• Maranda Rutledge, CSW
• Robert Walter Rutz, MD
• RX Medical Products LLC

• Physical Therapist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.