Individual provider Active NPI

David Russell

  • Family Medicine Physician
  • Huntington Beach, CA
National Provider Identifier
1578022810
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A181730 Issued in CA
Practice address
19582 Beach Blvd Ste 250
Huntington Beach, CA 92648-5977
Phone
(714) 477-8020
NPI assigned
Mar 17, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A181730 CA Primary

Addresses

Primary practice location

19582 Beach Blvd Ste 250
Huntington Beach, CA 92648-5977

Mailing address

19582 Beach Blvd Ste 250
Huntington Beach, CA 92648-5977

Other practice location 1

4445 Magnolia Ave Ofc
Riverside, CA 92501-4135
Phone (951) 788-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221116002761 CA Practitioner - Family Practice 6406224872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hoag ClinicGroup PAC ID 3274872064, 447 clinicians

Practice addresses (Care Compare)

19582 Beach Blvd
Suite 250
Huntington Beach, CA 92648-5977
Phone (714) 477-8020

Hospital & facility affiliations

  • Hoag Home Health Home health agency, Newport Beach, CA, CCN 557412
  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

Merit-based Incentive Payment System (MIPS)

Final score
87.51 of 100Reported as group
Quality
84.12
Promoting interoperability
100
Improvement activities
40
Cost
74.24

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A181730CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hoag Clinic CurrentSince Sep 8, 2022 Accepting new patients

Locations

19582 Beach Blvd
Ste 250
Huntington Beach, CA 92648
Phone (714) 378-4995

1 Hoag Dr
Newport Beach, CA 92663
Phone (877) 742-4624

1031 Avenida Pico
Ste 204
San Clemente, CA 92673
Phone (949) 829-5533

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1552780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1578022810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19582 BEACH BLVD STE 250",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926485977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19582 BEACH BLVD STE 250",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926485977",
            "telephone_number": "714-477-8020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4445 Magnolia Ave Ofc",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925014135",
            "country_code": "US",
            "telephone_number": "951-788-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-17",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A181730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.