Individual provider Active NPI

Robert Cody Russell

  • Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1801286059
Registry record updated Jan 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1-130087 Issued in AL
Practice address
1118 Ross Clark Circle, Suite 100
Dothan, AL 36301
Phone
(334) 794-1148
NPI assigned
Jan 27, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-130087 AL Primary

Addresses

Primary practice location

1118 Ross Clark Circle, Suite 100
Dothan, AL 36301

Mailing address

1118 Ross Clark Circle, Suite 100
Dothan, AL 36301
Phone (334) 794-1148

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20160624000715 AL Practitioner - Nurse Practitioner 1456650068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dothan Medical Associates, P.C.Group PAC ID 7416848247, 17 clinicians

Practice addresses (Care Compare)

1118 Ross Clark Cir
Suite 100
Dothan, AL 36301-3023
Phone (334) 794-1148

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-130087ALMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dothan Medical Associates, P.C. CurrentSince May 18, 2016 Accepting new patients

Locations

1118 Ross Clark Cir
Ste 100
Dothan, AL 36301
Phone (334) 794-1148

Interoperability endpoints

  • Direct secure messaging: rrussell@dmapc.gwaydirect.com
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.37

Organizations & group practices 1

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 1

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": "1422316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1801286059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIRCLE, SUITE 100",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-794-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIRCLE, SUITE 100",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-794-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ROBERT",
        "middle_name": "CODY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-130087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.