David Julius Russell, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

20A14817 Issued in CA

Practice address

1617 N California St
Ste. 2F
Stockton, CA 95204-6117

Phone

(209) 466-8546

Fax

(209) 466-3335

NPI assigned

Jun 28, 2012

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

Medicare fee-for-service enrollment

Enrolled in CA, SC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Obstetrics/Gynecology

Education

Philadelphia College of Osteopathic Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kraemer Women'S Care, LLCGroup PAC ID 3173696754, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles (2 of 3)

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: drussell543347@direct.musc.edu
• Direct secure messaging: drussell860156@direct.ghs.myhfn.org

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.

• Kraemer Womens Care, LLC

  • Obstetrics & Gynecology Physician
  • Columbia, SC
  • NPI 1124201280

  Obstetrics & Gynecology, SC

  Medicare reassignment Care Compare group NPD
• P. Gill Obstetrics & Gynecology Medical Group, Inc.

  • Obstetrics & Gynecology Physician
  • Lodi, CA
  • NPI 1386636165

  CA, Obstetrics & Gynecology

  Medicare reassignment NPD
• Uwh of the Carolinas, PLLC

  • Obstetrics & Gynecology Physician
  • Morrisville, NC
  • NPI 1639506470

  SC

  Medicare reassignment

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1659635134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952411090",
            "telephone_number": "209-334-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 N CALIFORNIA ST",
            "address_2": "STE. 2F",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046117",
            "telephone_number": "209-466-8546",
            "fax_number": "209-466-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "DAVID",
        "middle_name": "JULIUS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-28",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "20A14817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista Runnings, DPT
• Rikhart Dok Rupnik, DOCTOR PUBLIC HEALTH
• Kelli Marie Rushine
• Raina Russell-Shaffer, MSN, FNP-C
• David Russell, PMHNP
• Guy R. Russell
• Jason L Russell
• Sasha Russell
• Christopher Adamo Russo, DO, MPH
• Peter Joseph Russo, PA

• All providers in Stockton, CA
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.