Edward L. Russell, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01214 Issued in TX

Practice address

720 Pleasanton Rd
San Antonio, TX 78214-1306

Phone

(210) 921-3800

Fax

(210) 334-2851

NPI assigned

Sep 2, 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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• South Texas Ancillary Services, LTD

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1063670289
  Medicare reassignment
• Central Cardiovascular Institute of San Antonio

  • Specialist
  • San Antonio, TX
  • NPI 1184618050
  NPD (past)
• Greater San Antonio Emergency Physicians, PA

  • Emergency Medicine Physician
  • San Antonio, TX
  • NPI 1134184831
  NPD (past)
• Ucp Physicians of Central Texas, PLLC

  • Urgent Care Clinic/Center
  • Austin, TX
  • NPI 1154472967
  NPD (past)

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421020800000",
    "number": "1689776411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 PLEASANTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782141306",
            "telephone_number": "210-921-3800",
            "fax_number": "210-334-2861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 PLEASANTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782141306",
            "telephone_number": "210-921-3800",
            "fax_number": "210-334-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "EDWARD",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2015-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charly Ann Russell, BT
• Christina L Russell, PA
• Christina Louise Russell, LPC
• Delisa Duncan Russell, LPC-S
• Douglas Russell, DO
• Kathryn Russell, PA-C
• Lauren Russell
• Laurie Russell, PSYD
• Madison Russell
• Melissa Lane Russell, AU.D.

• Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.