Active NPI
Nancy Kae Russell, M.D.
- Internal Medicine Physician
- Kansas City, MO
National Provider Identifier
1790875425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 36094
- Practice address
- 5140 NE Antioch Rd
Nurturing Optimal Wellness
Kansas City, MO 64119-2523 - Phone
- (816) 453-5545
- Fax
- (800) 261-2718
- NPI assigned
- Oct 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 36094 | MO | Primary |
Addresses
Primary practice location
5140 NE Antioch Rd
Nurturing Optimal Wellness
Kansas City, MO 64119-2523
Mailing address
5140 NE Antioch Rd
Nurturing Optimal Wellness
Kansas City, MO 64119-2523
Phone (816) 453-5545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12799020 | Other | MO | NON-PROVIDER # BCBS |
| 68517 | Other | KS | NON-PROVIDER # BCBS KS |
Other names 1
- Dr. Nancy K. Russell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 17, 2010 through Jul 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544140800000",
"number": "1790875425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5140 NE ANTIOCH RD",
"address_2": "NURTURING OPTIMAL WELLNESS",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641192523",
"telephone_number": "816-453-5545",
"fax_number": "800-261-2718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5140 NE ANTIOCH RD",
"address_2": "NURTURING OPTIMAL WELLNESS",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641192523",
"telephone_number": "816-453-5545",
"fax_number": "800-261-2718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "NANCY",
"middle_name": "KAE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-13",
"last_updated": "2018-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "36094",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NON-PROVIDER # BCBS",
"identifier": "12799020",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NON-PROVIDER # BCBS KS",
"identifier": "68517",
"state": "KS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "NANCY",
"last_name": "RUSSELL",
"middle_name": "K.",
"prefix": "DR.",
"credential": "M.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.