NPIMap

Individual provider Active NPI

Russell Eugene Mayo, MD

  • Family Medicine Physician
  • Texarkana, AR
National Provider Identifier
1568469211
Registry record updated Oct 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C6443 Issued in AR
Practice address
300 E 6TH St
Texarkana, AR 71854-5207
Phone
(870) 779-6000
Fax
(870) 779-6093
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C6443 AR Primary
Family Medicine Physician 207Q00000X G9874 TX

Addresses

Primary practice location

300 E 6TH St
Texarkana, AR 71854-5207

Mailing address

300 E 6TH St
Texarkana, AR 71854-5207
Phone (870) 779-6000

Other identifiers 2

IdentifierTypeStateIssuer
137635206MedicaidTX
106188001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040917001130 AR Practitioner - Family Practice 8527036573 Reassigns benefits to 1 organization
I20100603000592 TX Practitioner - Family Practice 8527036573 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Arkansas for Medical SciencesGroup PAC ID 4082528955, 1,159 clinicians

Practice addresses (Care Compare)

2600 Saint Michael Dr
Texarkana, TX 75503-2372
Phone (903) 614-1000

3417 U of a Way
Texarkana, AR 71854-1419
Phone (870) 779-6000

Hospital & facility affiliations

  • Elite Home Health Home health agency, Nashville, AR, CCN 047138
  • Enhabit Home Health Home health agency, Longview, TX, CCN 679079
  • Centerwell Home Health Home health agency, Texarkana, AR, CCN 047838
  • Amedisys Home Health Home health agency, De Queen, AR, CCN 047056
  • Gentiva Hospice, Texarkana, TX, CCN 451583
  • Dierksen Memorial Hospice Hospice, Texarkana, AR, CCN 041572
  • Dierksen Hospice Hospice, Texarkana, TX, CCN 671514
  • Gentiva Hospice, Texarkana, AR, CCN 041532
  • Christus St Michael Health System Hospital, Texarkana, TX, CCN 450801
  • University of Arkansas Medical Sciences Hospital, Little Rock, AR, CCN 040016
  • Little River Memorial Hospital Hospital, Ashdown, AR, CCN 041320
  • The Springs of Texarkana Nursing home, Texarkana, AR, CCN 045211

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C6443ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences Family Medicine CurrentSince Jan 1, 1993 Accepting new patients
Icare Pro of Texas Aco Billing Professional Association CurrentSince Jun 1, 2023 Accepting new patients
University of Arkansas for Medical Sciences Family Medicine CurrentSince Jan 1, 1993 Accepting new patients
Christus Health Ark-la-Tex Past Accepting new patients
Winnie-Stowell Hospital District Past Accepting new patients
Texarkana Emergency Medicine Physicians,PA Past Accepting new patients
University of Arkansas for Medical Sciences Family Medicine Past Accepting new patients
Horizons General Partnership Past Accepting new patients

Locations

300 E 6th St
Texarkana, AR 71854
Phone (870) 779-6000

3417 U of a Way
Texarkana, AR 71854
Phone (870) 779-6000

4114 McKnight Rd
Ste C
Texarkana, TX 75503
Phone (501) 492-0099

1000 Pine St
Texarkana, TX 75501
Phone (903) 798-7365

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Interoperability endpoints

  • Direct secure messaging: rmayo310865@christushealth.direct-ci.net

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Dierksen HospiceTexarkana, TX, CCN 671514 Hospice Contracted Managing Employee Aug 1, 2022
GentivaTexarkana, TX, CCN 451583 Hospice Contracted Managing Employee Apr 19, 2019
Dierksen HospiceTexarkana, AR, CCN 041572 Hospice Contracted Managing Employee Feb 1, 2019
Retreat Health Care Services IncTexarkana, TX, CCN 971618 Hospice Corporate Director Jul 1, 2022

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382572800000",
    "number": "1568469211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E 6TH ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718545207",
            "telephone_number": "870-779-6000",
            "fax_number": "870-779-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 6TH ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718545207",
            "telephone_number": "870-779-6000",
            "fax_number": "870-779-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYO",
        "first_name": "RUSSELL",
        "middle_name": "EUGENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2013-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C6443",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G9874",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137635206",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106188001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, AR

Sources for this page

Verify at the official NPI Registry.