Russell A Dunckley, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

21515 Issued in TX

Practice address

3500 Oak Lawn Ave
Suite 275
Dallas, TX 75219-4308

Phone

(214) 522-0351

Fax

(214) 522-0593

NPI assigned

Aug 7, 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 TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1659380756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 OAK LAWN AVE",
            "address_2": "SUITE 275",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194308",
            "telephone_number": "214-522-0351",
            "fax_number": "214-522-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 OAK LAWN AVE",
            "address_2": "SUITE 275",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194308",
            "telephone_number": "214-522-0351",
            "fax_number": "214-522-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNCKLEY",
        "first_name": "RUSSELL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "21515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS TX",
            "identifier": "00D66R",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "75-2365650",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalonda Duncan
• Stephanie Duncan
• Duncanville Dental PLLC
• Duncanville Mental Health Services
• Duncanville Pain Partners, LLC
• Jeff M. Duncum, D.D.S.
• Colleen Dundas
• Sarah Elizabeth Dundas, M.S., RD/LD
• Jolie N Dunham, ACNP-BC
• Ryan Dunkin, B.A., M.S.

• Clinical Psychologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.