Active NPI
Amy Kay Russell
- Dental Assistant
- Portland, OR
National Provider Identifier
1659111771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 118534
- Practice address
- 1314 NE Grand Ave
Portland, OR 97232-1127 - Phone
- (503) 280-2877
- NPI assigned
- May 28, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 118534 | OR | Primary |
Addresses
Primary practice location
1314 NE Grand Ave
Portland, OR 97232-1127
Mailing address
9601 NE 302ND St
Battle Ground, WA 98604-7635
Phone (503) 453-6958
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118534 | OR | MD | Dental Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Permanente | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Hygienist
- Portland, OR
- NPI 1922011832
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716854400000",
"number": "1659111771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9601 NE 302ND ST",
"city": "BATTLE GROUND",
"state": "WA",
"postal_code": "986047635",
"telephone_number": "503-453-6958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1314 NE GRAND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321127",
"telephone_number": "503-280-2877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "AMY",
"middle_name": "KAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-28",
"last_updated": "2024-05-28",
"certification_date": "2024-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "OR",
"license": "118534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.