Active NPI
Jeffrey W Russell, MD
- Surgery Physician
- Fort Thomas, KY
National Provider Identifier
1659337988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 21322
- Practice address
- 85 N Grand Ave
2ND Floor
Fort Thomas, KY 41075-1793 - Phone
- (859) 781-2628
- Fax
- (859) 572-4403
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 35037666R | OH | |
| Surgery Physician | 208600000X | 21322 | KY | Primary |
Addresses
Primary practice location
85 N Grand Ave
2ND Floor
Fort Thomas, KY 41075-1793
Mailing address
85 N Grand Ave
2ND Floor
Fort Thomas, KY 41075-1793
Phone (859) 781-2628
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64213226 | Medicaid | KY | |
| 2564238 | Medicaid | OH |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21322 | KY | MD | Surgery Physician |
| 35037666R | OH | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Cincinnati Physicians Company, LLC | Surgery | 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.
-
- Family Medicine Physician
- Cincinnati, OH
- NPI 1801840434
Surgery
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350864000000",
"number": "1659337988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 N GRAND AVE",
"address_2": "2ND FLOOR",
"city": "FORT THOMAS",
"state": "KY",
"postal_code": "410751793",
"telephone_number": "859-781-2628",
"fax_number": "859-572-4403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 N GRAND AVE",
"address_2": "2ND FLOOR",
"city": "FORT THOMAS",
"state": "KY",
"postal_code": "410751793",
"telephone_number": "859-781-2628",
"fax_number": "859-572-4403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JEFFREY",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2012-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OH",
"license": "35037666R",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "KY",
"license": "21322",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64213226",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2564238",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Thomas, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.