Individual provider Active NPI

Isi Russ, MD

  • Emergency Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1609834498
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G37214 Issued in CA
Practice address
4060 E Whittier Blvd
Los Angeles, CA 90023-2526
Phone
(323) 268-5514
NPI assigned
May 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G37214 CA Primary

Addresses

Primary practice location

4060 E Whittier Blvd
Los Angeles, CA 90023-2526

Mailing address

PO Box 11600
Westminster, CA 92685-1600
Phone (562) 809-3541

Other identifiers 1

IdentifierTypeStateIssuer
00G372140MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G37214CAMDEmergency Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1609834498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11600",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926851600",
            "telephone_number": "562-809-3541",
            "fax_number": "562-468-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 E WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900232526",
            "telephone_number": "323-268-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSS",
        "first_name": "ISI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G37214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G372140",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.