Individual provider Active NPI

Stephanie Nicole Russell, AGPCNP

  • Nurse Practitioner
  • Elmira, NY
National Provider Identifier
1629598370
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
308433 Issued in NY
Practice address
200 Madison Ave Ste 2D
Elmira, NY 14901-3219
Phone
(607) 873-1832
Fax
(607) 873-1833
NPI assigned
Jun 23, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 308433 NY Primary

Addresses

Primary practice location

200 Madison Ave Ste 2D
Elmira, NY 14901-3219

Mailing address

571 Saint Josephs Blvd FL 2
Elmira, NY 14901-3230
Phone (607) 271-2050

Other identifiers 2

IdentifierTypeStateIssuer
103436736MedicaidPA
04882968MedicaidNY

Other names 1

  • Stephanie Nicole Parker Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20180102000957 NY Practitioner - Nurse Practitioner 2668748799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arnot Ogden Medical CenterGroup PAC ID 5395798417, 219 clinicians

Practice addresses (Care Compare)

200 Madison Ave
Suite 1D
Elmira, NY 14901-3219
Phone (607) 873-1832

Hospital & facility affiliations

  • Arnot Ogden Medical Center Hospital, Elmira, NY, CCN 330090

Merit-based Incentive Payment System (MIPS)

Final score
80.15 of 100Reported as group
Quality
46.76
Promoting interoperability
100
Improvement activities
40
Cost
77.08

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
308433NYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arnot Ogden Medical Center CurrentSince Jun 23, 2020 Accepting new patients
Arnot Ogden Medical Center CurrentSince Jun 23, 2020 Accepting new patients

Locations

200 Madison Ave
Ste 2D
Elmira, NY 14901
Phone (607) 271-3442

200 Madison Ave
Ste 1D
Elmira, NY 14901
Phone (607) 873-1832

600 Roe Ave
Ste 1F
Elmira, NY 14905
Phone (607) 795-8161

600 Roe Ave
Elmira, NY 14905
Phone (607) 733-3639

2977 Westinghouse Rd
Ste 3
Horseheads, NY 14845
Phone (607) 732-8475

Interoperability endpoints

  • Direct secure messaging: stephanie.russell@arn.eclinicaldirectplus.com
  • Direct secure messaging: srussell26842@direct.xtensys.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1629598370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050",
            "fax_number": "607-873-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MADISON AVE STE 2D",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013219",
            "telephone_number": "607-873-1832",
            "fax_number": "607-873-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "STEPHANIE",
        "middle_name": "NICOLE",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-23",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "308433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103436736",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04882968",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "PARKER",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elmira, NY

Sources for this page

Verify at the official NPI Registry.