John Russell, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD20256 Issued in ME

Practice address

22 Hartford St # Sr
Houlton, ME 04730-1844

Phone

(207) 532-4068

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Urologic Consultants, PLLC

  • Urology Physician
  • Puyallup, WA
  • NPI 1922112234
  NPD
• Proliance Surgeons, Inc., P.S.

  dba Puyallup Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Puyallup, WA
  • NPI 1083622112
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494892800000",
    "number": "1720013204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 3RD ST SE STE 210",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 HARTFORD ST # SR",
            "city": "HOULTON",
            "state": "ME",
            "postal_code": "047301844",
            "telephone_number": "207-532-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2017-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00027077",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ME",
            "license": "MD20256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Robson, RN
• Jamieson F Romanelli, PMHNP/MSN
• Sharon Andrea Romanelli
• Tessa V Roshto, RN
• Tory Rouse, FNP-C
• Thomas J. Ryan, D.O.
• Sad 29
• Sad 29
• Leslie Peters Sadler, LCSW
• Melissa Sanders, MHRT-CSP

• Urology Physician in Houlton, ME
• Providers in Houlton, ME by specialty
• Urology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.