Russell Brent Shields, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1551991205 Issued in UT

Practice address

425 N Medical Dr
Ste 108
Bountiful, UT 84010

Phone

(801) 292-8444

Fax

(801) 292-8476

NPI assigned

Oct 19, 2005

Last updated

Jan 21, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Russell B Shields MD PC

  • Family Medicine Physician
  • Bountiful, UT
  • NPI 1477543213
  Authorized official Same address or phone

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200873600000",
    "number": "1568451730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N MEDICAL DR",
            "address_2": "STE 108",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "801-292-8444",
            "fax_number": "801-292-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N MEDICAL DR",
            "address_2": "STE 108",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "801-292-8444",
            "fax_number": "801-292-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "RUSSELL",
        "middle_name": "BRENT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "1551991205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04714",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Eidenshink Shelly
• Elisabeth Sheridan, LCSW
• Rosemary Elin Sherlock, LCSW
• Jessica Elizabeth Sherman, PT, DPT
• Jay Glen Shields, DDS
• Adam Shirley
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 107)
• Shopko Stores Operating Co. LLC (ShopKo Optical 107)
• Kaden Earl Short
• Sydney Shuman

• Internal Medicine Physician in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Internal Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2008; 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.