NPIMap

Organization Active NPI

George Ray Russell MD PC

  • Dermatology Physician
  • Boulder, CO
National Provider Identifier
1588865646
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
17600 Issued in CO
Legal business name
GEORGE RAY RUSSELL MD PC
Practice address
1000 Alpine Ave
#50
Boulder, CO 80304-3409
Phone
(303) 444-4864
Fax
(303) 444-4865
NPI assigned
May 29, 2007
Last updated
May 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

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

Authorized official

Name
George R Russell, MDNPI 1932178241
Title
President
Phone
(303) 444-4864

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 17600 CO Primary

Addresses

Primary practice location

1000 Alpine Ave
#50
Boulder, CO 80304-3409

Mailing address

PO Box 18058
Boulder, CO 80308-1058
Phone (303) 444-4864

Other identifiers 2

IdentifierTypeStateIssuer
84307366MedicaidCO
GE667695OtherCOBCBS OF CO GROUP #

National Provider Directory

National Provider Directory

Locations

1000 Alpine Ave
Ste 50
Boulder, CO 80304
Phone (303) 444-4864

1120 Alpine Ave
Ste D
Boulder, CO 80304
Phone (303) 444-4864

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1588865646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18058",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803081058",
            "telephone_number": "303-444-4864",
            "fax_number": "303-444-4865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ALPINE AVE",
            "address_2": "#50",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043409",
            "telephone_number": "303-444-4864",
            "fax_number": "303-444-4865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE RAY RUSSELL MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-444-4864",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "17600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84307366",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF CO GROUP #",
            "identifier": "GE667695",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.