Mark L Russell, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

077986 Issued in CT

Practice address

125 Lasalle Rd
West Hartford, CT 06107-2322

Phone

(860) 906-1289

Fax

(860) 906-1269

NPI assigned

Jul 12, 2011

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 CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25497/brand/1/csg/1/fhir/r4

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.

• Pounds, Medical Weight Loss Transformation, PC

  • Obesity Medicine (Obstetrics & Gynecology) Physician
  • West Hartford, CT
  • NPI 1548676877
  NPD (past)

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1609164532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 LASALLE RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072322",
            "telephone_number": "860-906-1289",
            "fax_number": "860-906-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 LASALLE RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072322",
            "telephone_number": "860-906-1289",
            "fax_number": "860-906-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARK",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-12",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "077986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "077986",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Lee Rubinow, D.C., FIACA
• Ruby Psychiatric Services, PLLC
• Mary G Ruddat, MD
• Donald S Ruffett, MD
• David Michael Russell, PH.D.
• Gary Edward Russolillo, M.D.
• Michelle Rae Rusted
• Ruth L. Jacobson, Ms, LMFT, LLC
• Stanley J Rutstein, DPM
• Jack Ryan, LADC, LPC

• Nurse Practitioner in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.