Jeffrey Harold Russum, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34942 Issued in MN

Practice address

640 Jackson St
Saint Paul, MN 55101-2502

Phone

(651) 254-3456

Fax

(651) 254-9673

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jeffrey H Russum Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446681600000",
    "number": "1659345346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "651-254-3456",
            "fax_number": "651-254-9673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3456",
            "fax_number": "651-254-9673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSUM",
        "first_name": "JEFFREY",
        "middle_name": "HAROLD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2015-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "34942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "826590900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFFREY",
            "last_name": "RUSSUM",
            "middle_name": "H",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kellie Jean Rusch, APRN, CNP
• Walter Kenneth Rush IV, M.D.
• Christine Rushfeldt, LICSW, LADC
• Anne Russell
• Stacy Russell, LPCC
• Peter Karl Rusterholz, M.D.
• Cori L Rutchick, DC
• Ruth H. Tallakson, PHD, LP, LTD.
• Ruth Markowitz Ma LP
• Brenna Aden Rutherford, PAC

• Internal Medicine Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.