NPIMap

Individual provider Active NPI

Mark Russell, M.D.

  • Interventional Cardiology Physician
  • Victorville, CA
National Provider Identifier
1639137540
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
A144701 Issued in CA
Practice address
13024 Hesperia Rd Ste 103
Victorville, CA 92395-8303
Phone
(760) 241-3547
Fax
(760) 241-3562
NPI assigned
May 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X A144701 CA
Student in an Organized Health Care Education/Training Program 390200000X 229134 NY
Interventional Cardiology Physician 207RI0011X A144701 CA Primary
Internal Medicine Physician 207R00000X 229134 NY

Addresses

Primary practice location

13024 Hesperia Rd Ste 103
Victorville, CA 92395-8303

Mailing address

12223 Highland Ave # 106-536
Rancho Cucamonga, CA 91739-2574
Phone (760) 241-3547

Other practice location 1

600 E Williams St
Barstow, CA 92311-2943
Phone (760) 256-0328

Other names 1

  • Seyed-Mehrdad Alerassoul Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200115003098 CA Practitioner - Cardiac Electrophysiology 0244325629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ramin Ashtiani, MD a Professional CorporationGroup PAC ID 1153480991, 5 clinicians

Practice addresses (Care Compare)

600 E Williams St
Barstow, CA 92311-2943
Phone (760) 256-0328

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
71.21 of 100Reported as individual
Quality
41.67
Promoting interoperability
94
Improvement activities
0
Cost
84.04

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A144701CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ramin Ashtiani, MD a Professional Corporation CurrentSince Jan 1, 2020 Accepting new patients
St. Mary'S Regional Medical Center Past Accepting new patients
The New York and Presbyterian Hospital Past Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients
The Brookdale Hospital Medical Center Past Accepting new patients
Ascension Calumet Hospital, Inc Past Accepting new patients
Brookdale Hospital Medical Center Past Accepting new patients
The Brookdale Hospital Medical Center Past Accepting new patients

Locations

600 E Williams St
Barstow, CA 92311
Phone (760) 241-3547

12223 Highland Ave
Ste 106536
Rch Cucamonga, CA 91739

13024 Hesperia Rd
Ste 103
Victorville, CA 92395
Phone (760) 241-3547

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mark.russell@hca5.eclinicaldirectplus.com
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 8

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 7

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1639137540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12223 HIGHLAND AVE # 106-536",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917392574",
            "telephone_number": "760-241-3547",
            "fax_number": "760-241-3562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13024 HESPERIA RD STE 103",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923958303",
            "telephone_number": "760-241-3547",
            "fax_number": "760-241-3562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 E Williams St",
            "address_purpose": "LOCATION",
            "city": "Barstow",
            "state": "CA",
            "postal_code": "923112943",
            "country_code": "US",
            "telephone_number": "760-256-0328",
            "fax_number": "760-256-5635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A144701",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "229134",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A144701",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "229134",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SEYED-MEHRDAD",
            "last_name": "ALERASSOUL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.