Active NPI
Patrick Todd Russell, MD
- Internal Medicine Physician
- Tyler, TX
National Provider Identifier
1750356382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- K6781
- Practice address
- 800 E Dawson
Tyler, TX 75701 - Phone
- (903) 510-1186
- Fax
- (903) 525-1254
- NPI assigned
- Feb 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | K6781 | TX | Primary |
Addresses
Primary practice location
800 E Dawson
Tyler, TX 75701
Mailing address
PO Box 5500
Tyler, TX 75712-5500
Phone (903) 324-6400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 044058801 | Medicaid | TX |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K6781 | TX | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1750356382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5500",
"city": "TYLER",
"state": "TX",
"postal_code": "757125500",
"telephone_number": "903-324-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E DAWSON",
"city": "TYLER",
"state": "TX",
"postal_code": "75701",
"telephone_number": "903-510-1186",
"fax_number": "903-525-1254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "PATRICK",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-17",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TX",
"license": "K6781",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "044058801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.