NPIMap

Individual provider Active NPI

Michael Benjamin Russell, M.D.

  • Gastroenterology Physician
  • Boston, MA
National Provider Identifier
1730592387
Registry record updated Jul 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
275771 Issued in MA
Practice address
800 Washington St
Boston, MA 02111
Phone
(617) 636-5000
NPI assigned
Jun 10, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 275771 MA Primary

Addresses

Primary practice location

800 Washington St
Boston, MA 02111

Mailing address

391 Hyde Park Ave Apt 206
Boston, MA 02131-2166

Other practice location 1

20 York St
New Haven, CT 06510-3220
Phone (203) 688-4242

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170801003548 NC Practitioner - Internal Medicine 0042530040 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Duke University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cabarrus Gastroenterology Associates PLLCGroup PAC ID 9436059649, shared by 3 NPIs, 51 clinicians

Practice addresses (Care Compare)

1070 Vinehaven Dr NE
Concord, NC 28025-2438
Phone (704) 783-1840

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy70
Upper gastrointestinal (GI) endoscopy for acid reflux80

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
275771MAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
Cabarrus Gastroenterology Associates, PLLC Gastroenterology CurrentSince Apr 1, 2021 Accepting new patients
Cabarrus Gastroenterology Associates, PLLC CurrentSince Apr 1, 2021 Accepting new patients
Cabarrus Gastroenterology Associates, PLLC Gastroenterology CurrentSince Apr 1, 2021 Accepting new patients
Duke University Health System, Inc. CurrentSince Jul 1, 2017 Accepting new patients
Cabarrus Gastroenterology Associates, PLLC Past Accepting new patients
Novant Health Rowan Endoscopy Center, LLC PastSince Jun 30, 2024 Accepting new patients

Locations

9965 Poplar Tent Rd
Concord, NC 28027
Phone (704) 783-1840

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

1070 Vinehaven Dr NE
Concord, NC 28025
Phone (704) 783-1840

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

3400 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 954-3000

522 Corporate Cir
Salisbury, NC 28147
Phone (704) 210-6918

510 Corporate Cir
#1001
Salisbury, NC 28147
Phone (704) 783-1840

510 Corporate Cir
#1000
Salisbury, NC 28147
Phone (704) 783-1840

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

Organizations & group practices 7

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 12

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": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530662400000",
    "number": "1730592387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 HYDE PARK AVE APT 206",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021312166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02111",
            "telephone_number": "617-636-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 York St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103220",
            "country_code": "US",
            "telephone_number": "203-688-4242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MICHAEL",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-10",
        "last_updated": "2018-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "275771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.