Individual provider Active NPI

Sarah Russell, FNP-C

  • Nurse Practitioner
  • Bay Springs, MS
National Provider Identifier
1649037904
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
906491 Issued in MS
Practice address
2761 Highway 15
Bay Springs, MS 39422-7432
Phone
(601) 764-2419
NPI assigned
Mar 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Registered Nurse 163WC0400X 908687 MS
Nurse Practitioner 363L00000X 906491 MS Primary

Addresses

Primary practice location

2761 Highway 15
Bay Springs, MS 39422-7432

Mailing address

2761 Highway 15
Bay Springs, MS 39422-7432
Phone (601) 764-2419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20241004003291 MS Practitioner - Nurse Practitioner 7517498207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ms State Department of HealthGroup PAC ID 0244129245, 21 clinicians

Practice addresses (Care Compare)

1850 Cheryl St
Clarksdale, MS 38614-7219
Phone (662) 624-8316

570 E Woodrow Wilson Ave
Jackson, MS 39216-4538
Phone (601) 576-7345

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
908687MSMDCase Management Registered Nurse
906491MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ms State Department of Health CurrentSince Sep 1, 2024 Accepting new patients
Ms State Dept of Health CurrentSince Sep 1, 2024 Accepting new patients
Mississippi State Department of Health Current Accepting new patients
Mississippi State Department of Health PastSince Mar 12, 2024 Accepting new patients

Locations

2761 Highway 15
Bay Springs, MS 39422
Phone (601) 764-2419

570 E Woodrow Wilson Ave
Jackson, MS 39216
Phone (601) 576-7345

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1649037904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2761 HIGHWAY 15",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394227432",
            "telephone_number": "601-764-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2761 HIGHWAY 15",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394227432",
            "telephone_number": "601-764-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SARAH",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "MS",
            "license": "908687",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "906491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Springs, MS

Sources for this page

Verify at the official NPI Registry.