Individual provider Active NPI

Patrick Kelly Russell, DNAP, CRNA

  • Certified Registered Nurse Anesthetist
  • Montclair, NJ
National Provider Identifier
1699485227
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NJ01401400 Issued in NJ
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

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230227000906 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244603066 Reassigns benefits to 1 organization
I20260115001406 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244603066 Reassigns benefits to 1 organization

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
New Jersey Healthcare Specialists PCGroup PAC ID 2668385253, 570 clinicians
CHS Anesthesia Services Group IncGroup PAC ID 5799007324, 742 clinicians

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 Hospital, Montclair, NJ, CCN 310054
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7877NCMDProfessional Counselor
95001877CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Healthcare Specialists PC CurrentSince Jan 1, 2023 Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Feb 9, 2026 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.

Hospital & facility affiliations 7

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": "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.

Verify at the official NPI Registry.