Active NPI
Patrick Kelly Russell, DNAP, CRNA
- Certified Registered Nurse Anesthetist
- Montclair, NJ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 26NJ01401400
- Practice address
- 1 Bay Ave
Montclair, NJ 07042-4837 - Phone
- (973) 429-6000
- NPI assigned
- Dec 5, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 95001877 | CA | |
| Certified Registered Nurse Anesthetist | 367500000X | 26NJ01401400 | NJ | Primary |
Addresses
Primary practice location
1 Bay Ave
Montclair, NJ 07042-4837
Mailing address
157 Clarken Dr
West Orange, NJ 07052-3429
Phone (619) 675-4910
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ, NC
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Bay Ave
Montclair, NJ 07042-4837
Phone (973) 429-6000
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000
8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6000
Hospital & facility affiliations
- Hackensack Meridian Mountainside Medical
- Carolinas Medical Center/Behav Health
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7877 | NC | MD | Professional Counselor |
| 95001877 | CA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Jersey Healthcare Specialists PC | Current | Accepting new patients | |
| CHS Anesthesia Services Group Inc | Current | Accepting new patients |
Locations
30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066
1 Bay Ave
Montclair, NJ 07042
Phone (973) 429-6100
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Hackensack, NJ
- NPI 1174585780
-
- Anesthesiology Physician
- Charlotte, NC
- NPI 1346649415
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Montclair, NJ
- NPI 1982720249
-
- Psychiatric Hospital Unit
- Charlotte, NC
- NPI 1053358945
-
- General Acute Care Hospital
- Charlotte, NC
- NPI 1295789907
-
- General Acute Care Hospital
- Charlotte, NC
- NPI 1376985135
-
- Children's Rehabilitation Hospital
- Charlotte, NC
- NPI 1699829887
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Charlotte, NC
- NPI 1720029705
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670198400000",
"number": "1699485227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "157 CLARKEN DR",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070523429",
"telephone_number": "619-675-4910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BAY AVE",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070424837",
"telephone_number": "973-429-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "PATRICK",
"middle_name": "KELLY",
"name_prefix": "Dr.",
"credential": "DNAP, CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-12-05",
"last_updated": "2022-12-05",
"certification_date": "2022-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "CA",
"license": "95001877",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NJ",
"license": "26NJ01401400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Montclair, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; 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.