Active NPI
James Timothy Russin, DDS
- Endodontics
- Brandon, FL
National Provider Identifier
1609879311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN 10828
- Practice address
- 123 N Oakwood Ave
Brandon, FL 33510-4629 - Phone
- (813) 684-6509
- Fax
- (813) 685-9447
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN 10828 | FL | Primary |
Addresses
Primary practice location
123 N Oakwood Ave
Brandon, FL 33510-4629
Mailing address
123 N Oakwood Ave
Brandon, FL 33510-4629
Phone (813) 684-6509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150803001830 | FL | Order and Referring Only - Oral Surgery | 9537473616 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 10828 | FL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288915200000",
"number": "1609879311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 N OAKWOOD AVE",
"city": "BRANDON",
"state": "FL",
"postal_code": "335104629",
"telephone_number": "813-684-6509",
"fax_number": "813-685-9447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 N OAKWOOD AVE",
"city": "BRANDON",
"state": "FL",
"postal_code": "335104629",
"telephone_number": "813-684-6509",
"fax_number": "813-685-9447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSIN",
"first_name": "JAMES",
"middle_name": "TIMOTHY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2010-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN 10828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; 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.