Individual provider Active NPI

Russell Scott Robinson, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1699176255
Registry record updated Oct 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5788 Issued in AZ
Practice address
1108 W Indian School Rd
Phoenix, AZ 85013-3107
Phone
(602) 773-5600
Fax
(602) 773-5601
NPI assigned
Sep 12, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5788 AZ Primary

Addresses

Primary practice location

1108 W Indian School Rd
Phoenix, AZ 85013-3107

Mailing address

1108 W Indian School Rd
Ste B
Phoenix, AZ 85013-3107
Phone (602) 773-5600

Other identifiers 2

IdentifierTypeStateIssuer
Z173607OtherAZPTAN
975247MedicaidAZ

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20180710000339 UT Practitioner - Physician Assistant 5890011951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

2075 N 1200
Layton, UT 84041-1611
Phone (801) 779-6200

2075 University Park Blvd
Layton, UT 84041-1611
Phone (801) 387-6200

5323 S Woodrow St
Murray, UT 84107-5841
Phone (801) 261-8346

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

75 N 2260
Hurricane, UT 84737-2034
Phone (435) 251-2650

9450 S 1300
Sandy, UT 84094-5555
Phone (801) 501-6250

Hospital & facility affiliations

  • St. George Regional Hospital Hospital, St George, UT, CCN 460021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5788AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince May 19, 2018 Accepting new patients
Ihc Health Services Inc CurrentSince May 19, 2018 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

75 N 2260 W
Hurricane, UT 84737
Phone (435) 635-6400

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443657600000",
    "number": "1699176255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 W INDIAN SCHOOL RD",
            "address_2": "STE B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133107",
            "telephone_number": "602-773-5600",
            "fax_number": "602-773-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 W INDIAN SCHOOL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133107",
            "telephone_number": "602-773-5600",
            "fax_number": "602-773-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBINSON",
        "first_name": "RUSSELL",
        "middle_name": "SCOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-12",
        "last_updated": "2015-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "Z173607",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "975247",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.