Russel Nichols, MD, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD22062 Issued in OR

Legal business name

RUSSEL NICHOLS, MD, PC

Practice address

135 Ford Rd
John Day, OR 97845-2010

Phone

(541) 575-2669

Fax

(541) 575-2743

NPI assigned

Jul 8, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Russel James Nichols, MD

Title

Owner

Phone

(541) 575-2669

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609874247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 FORD RD",
            "city": "JOHN DAY",
            "state": "OR",
            "postal_code": "978452010",
            "telephone_number": "541-575-2669",
            "fax_number": "541-575-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 FORD RD",
            "city": "JOHN DAY",
            "state": "OR",
            "postal_code": "978452010",
            "telephone_number": "541-575-2669",
            "fax_number": "541-575-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSEL NICHOLS, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "RUSSEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-575-2669",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD22062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC/DME",
            "identifier": "4532990001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287633",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LICENSE NUMBER",
            "identifier": "MD00039026",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth L Peterson, D.M.D.
• Susan Linda Philo, RDH
• Rays of Hope Counseling LLC
• Sylvia Michelle Ross
• Sarah Russ, PT
• Karla Salisbury-Colson
• Janessa S Sickler, D.O.
• Tilli Obrina Slusarenko, PHARMD
• Rosalyn Smarr, LMT
• Jennifer Smoot

• Family Medicine Physician in John Day, OR
• Providers in John Day, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.