Kathryn White Russell, MD

Key facts

NPI

1750518049

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Surgery Physician 2086S0120X

License

MT207856 (PA)

Practice address

3401 Civic Center Blvd
Division of Pediatric Surgery
Philadelphia, PA 19104-4319

Phone

(215) 590-1190

NPI assigned

Jun 15, 2009

Sex

Female

Sole proprietor

Yes

Organizations & group practices 8

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.

• Ihc Health Services Inc Multi-Specialty Clinic/Center · Sandy, UT · NPI 1942325154
  Medicare reassignment NPD UT
• University of Utah Pediatric Services Pediatrics Physician · Salt Lake City, UT · NPI 1487018974
  Medicare reassignment NPD UT
• Ihc Health Services Inc Emergency Medicine Physician · Park City, UT · NPI 1861757478
  NPD
• Ihc Health Services, Inc. Psychiatry Physician · St George, UT · NPI 1023843844
  NPD
• University of Utah Pediatric Services Pediatric Infectious Diseases Physician · Salt Lake City, UT · NPI 1285098855
  NPD
• University of Utah Pediatric Services Pediatric Pathology Physician · Salt Lake City, UT · NPI 1891159935
  NPD
• SCL Health Medical Group - Billings LLC Clinic/Center · Billings, MT · NPI 1508289703
  NPD (past)
• University of Utah Pediatric Services Pediatrics Physician · Riverton, UT · NPI 1043671985
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 17, 2021.

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1750518049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "DIVISION OF PEDIATRIC SURGERY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "DIVISION OF PEDIATRIC SURGERY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KATHRYN",
        "middle_name": "WHITE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "PA",
            "license": "MT207856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krussell70095@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

• Darleen Russell
• Eddie Russell, CRNA
• Heather Flynn Russell, PHD
• James E Russell, MD
• Jonathan M Russell, MD
• Kayla Anne Russell, RN
• Keith Russell
• Kimberly Muro Russell, PA-C
• Madeline Russell
• Pamela Russell, MD

All providers in Philadelphia, PA · Pediatric Surgery Physician in Pennsylvania