Individual provider Active NPI

Russell Thomas Janssen, D.C.

  • Chiropractor
  • Clearwater, FL
National Provider Identifier
1669653911
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH0004460 Issued in FL
Practice address
2519 N McMullen Booth Rd
Suite 201
Clearwater, FL 33761-4173
Phone
(727) 726-8822
Fax
(727) 796-9139
NPI assigned
Nov 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH0004460 FL Primary

Addresses

Primary practice location

2519 N McMullen Booth Rd
Suite 201
Clearwater, FL 33761-4173

Mailing address

2519 N McMullen Booth Rd
Suite 201
Clearwater, FL 33761-4159
Phone (727) 726-8822

Other identifiers 3

IdentifierTypeStateIssuer
350005997OtherFLRR MEDICARE
381371100MedicaidFL
T54967OtherFLUPIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080206000425 FL Practitioner - Chiropractic 4183707763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2535 Landmark Dr
Suite 213
Clearwater, FL 33761-3930
Phone (727) 726-8822

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH0004460FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
RTJ DC Inc Chiropractor CurrentSince May 1, 2005 Accepting new patients

Locations

2519 N McMullen Booth Rd
Ste 201
Clearwater, FL 33761
Phone (727) 726-8822

2535 Landmark Dr
Ste 213
Clearwater, FL 33761
Phone (727) 726-8822

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.

NPI Registry JSON

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1669653911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 N MCMULLEN BOOTH RD",
            "address_2": "SUITE 201",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337614159",
            "telephone_number": "727-726-8822",
            "fax_number": "727-796-9139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 N MCMULLEN BOOTH RD",
            "address_2": "SUITE 201",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337614173",
            "telephone_number": "727-726-8822",
            "fax_number": "727-796-9139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSSEN",
        "first_name": "RUSSELL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-15",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0004460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "350005997",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381371100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "T54967",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.