Kelly Russin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004096 Issued in GA

Practice address

6325 Shannon Pkwy
Suite D
Union City, GA 30291-1538

Phone

(770) 964-1400

Fax

(770) 306-1343

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southside Medical CareGroup PAC ID 9931180650, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Southside Medical Care

  • Family Medicine Physician
  • Union City, GA
  • NPI 1376752311
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1780745554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6325 SHANNON PKWY",
            "address_2": "SUITE D",
            "city": "UNION CITY",
            "state": "GA",
            "postal_code": "302911538",
            "telephone_number": "770-964-1400",
            "fax_number": "770-306-1343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 SHANNON PKWY",
            "address_2": "SUITE D",
            "city": "UNION CITY",
            "state": "GA",
            "postal_code": "302911538",
            "telephone_number": "770-964-1400",
            "fax_number": "770-306-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSIN",
        "first_name": "KELLY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rapid Premiere LLC
• Shalon Reed
• Shae-Dee Reigns, LCSW
• Reliable Medical Supply LLC
• Angie Layla Rodriguez
• Frederick A Saddler
• Sana Kare LLC
• Crystal M Scott, MSW
• Nicole Elise Scott
• Cara Sevier, RN

• Physician Assistant in Union City, GA
• Providers in Union City, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.