Individual provider Active NPI

Debra Kaye Russell, M.D.

  • Diagnostic Radiology Physician
  • Fort Smith, AR
National Provider Identifier
1730159914
Registry record updated Apr 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
E1315 Issued in AR
Practice address
1001 Towson Ave
Fort Smith, AR 72901-4921
Phone
(479) 441-4000
NPI assigned
Jan 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 20630 OK
Diagnostic Radiology Physician 2085R0202X E1315 AR Primary

Addresses

Primary practice location

1001 Towson Ave
Fort Smith, AR 72901-4921

Mailing address

PO Box 1983
Fort Smith, AR 72902-1983
Phone (479) 452-9416

Other identifiers 2

IdentifierTypeStateIssuer
100077300AMedicaidOK
134580001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050512000500 AR Practitioner - Diagnostic Radiology 0042251746 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20630OKMDSocial Worker
E1315ARMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Services P a Diagnostic Radiology CurrentSince Feb 1, 1999 Accepting new patients
R and a Radiology LLP Diagnostic Radiology Past Accepting new patients

Locations

1001 Towson Ave
Fort Smith, AR 72901
Phone (479) 441-3980

310 Lexington Ave
Fort Smith, AR 72901
Phone (479) 494-0500

105 Wall St
Poteau, OK 74953
Phone (918) 635-3100

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.

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1730159914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1983",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729021983",
            "telephone_number": "479-452-9416",
            "fax_number": "479-484-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 TOWSON AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729014921",
            "telephone_number": "479-441-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "DEBRA",
        "middle_name": "KAYE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "20630",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AR",
            "license": "E1315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100077300A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134580001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.