Individual provider Active NPI

Brett Russell, QMHA II, CADC II

  • Case Manager/Care Coordinator
  • Medford, OR
National Provider Identifier
1720768393
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
License
NO.23-QMHA-II-000082 Issued in OR
Practice address
140 S Holly St
Medford, OR 97501-3113
Phone
(541) 774-3851
NPI assigned
Jul 19, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X NO.23-QMHA-II-000082 OR Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 22-R-09 OR

Addresses

Primary practice location

140 S Holly St
Medford, OR 97501-3113

Mailing address

140 S Holly St
Medford, OR 97501-3113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
NO.23-QMHA-II-000082ORMDCase Manager/Care Coordinator

NPI Registry JSON

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1720768393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 S HOLLY ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975013113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S HOLLY ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975013113",
            "telephone_number": "541-774-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "BRETT",
        "credential": "QMHA II, CADC II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-19",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "NO.23-QMHA-II-000082",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "22-R-09",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; 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.