NPIMap

Individual provider Active NPI

Russell Evan Bandstra, M.D.

  • Urology Physician
  • Pella, IA
National Provider Identifier
1619948098
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
28246 Issued in IA
Practice address
405 Monroe St
Pella, IA 50219-1189
Phone
(641) 621-2383
Fax
(641) 621-2632
NPI assigned
Feb 1, 2006
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 28246 IA Primary

Addresses

Primary practice location

405 Monroe St
Pella, IA 50219-1189

Mailing address

405 Monroe St
Pella, IA 50219-1290
Phone (641) 621-2383

Other practice location 1

122 4th Ave
Grinnell, IA 50112-1829
Phone (641) 621-2383

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address prhc@direct.pellahealth.kobledirect.com Direct
Direct Messaging Address prhc@direct.pellahealth.kobledirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040414000710 IA Practitioner - Urology 1951395631 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Iowa, RJ & L Carver College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pella Regional Health CenterGroup PAC ID 9931005873, shared by 10 NPIs, 96 clinicians

Practice addresses (Care Compare)

122 4TH Ave
Grinnell, IA 50112-1829
Phone (641) 621-2383

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.84 of 100Reported as group
Quality
91.13
Promoting interoperability
100
Improvement activities
40
Cost
81.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28246IAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pella Regional Health Center CurrentSince Jul 1, 2021 Accepting new patients
Pella Regional Health Center CurrentSince Jul 1, 2021 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Pella Regional Health Center Current Accepting new patients
Knoxville Community Hospital Inc CurrentSince Apr 1, 2019 Accepting new patients
Knoxville Community Hospital Inc Current Accepting new patients

Locations

122 4th Ave
Grinnell, IA 50112
Phone (641) 236-4323

1002 S Lincoln St
Knoxville, IA 50138
Phone (641) 842-1464

1202 W Howard St
Knoxville, IA 50138
Phone (641) 828-7144

405 Monroe St
Pella, IA 50219
Phone (641) 621-2200

Interoperability endpoints

  • Direct secure messaging: rbandstra671999@direct.unitypoint.org
  • Direct secure messaging: russellbandstra@sagllp.allscriptsdirect.net

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1619948098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MONROE ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191290",
            "telephone_number": "641-621-2383",
            "fax_number": "641-621-2632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MONROE ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191189",
            "telephone_number": "641-621-2383",
            "fax_number": "641-621-2632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 4th Ave",
            "address_purpose": "LOCATION",
            "city": "Grinnell",
            "state": "IA",
            "postal_code": "501121829",
            "country_code": "US",
            "telephone_number": "641-621-2383",
            "fax_number": "641-621-2632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANDSTRA",
        "first_name": "RUSSELL",
        "middle_name": "EVAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IA",
            "license": "28246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prhc@direct.pellahealth.kobledirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "405 Monroe St",
            "city": "Pella",
            "state": "IA",
            "country_code": "US",
            "postal_code": "502191189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prhc@direct.pellahealth.kobledirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "122 4th Ave",
            "city": "Grinnell",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501121829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pella, IA

Sources for this page

Verify at the official NPI Registry.