Russell Leon Ingram, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

7858 Issued in AL

Practice address

1460 2ND Ave SW
Jacksonville, AL 36265-3358

Phone

(256) 435-2180

Fax

(256) 435-9525

NPI assigned

Sep 8, 2005

Reactivated

Apr 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25282/brand/1/csg/1/fhir/r4

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.

• Norwood Clinic Inc

  • Multi-Specialty Clinic/Center
  • Birmingham, AL
  • NPI 1104879741
  NPD (past)

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185408000000",
    "number": "1639163397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 2ND AVE SW",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362653358",
            "telephone_number": "256-435-2180",
            "fax_number": "256-435-9525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 2ND AVE SW",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362653358",
            "telephone_number": "256-435-2180",
            "fax_number": "256-435-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "RUSSELL",
        "middle_name": "LEON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2007-07-26",
        "deactivation_date": "2006-03-25",
        "reactivation_date": "2006-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "7858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51519662",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051519662",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Joanna Holcomb, LPC
• Tracey Hudgins, LPC
• Brian Russell Ingram, DO
• Chandler Austin Ingram
• Megan Ingram, PHARM D
• Jacksonville Anesthesia LLC
• Jacksonville Aristo ER, LLC
• Jacksonville City
• Jacksonville Emergency Physicians LLC
• Jacksonville Health and Rehabilitation, LLC

• Family Medicine Physician in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.

Verify at the official NPI Registry.