Russell Peckham, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

P5120 Issued in TX

Practice address

7200 Wyoming SPGS
Suite 300
Round Rock, TX 78681-4303

Phone

(512) 910-8800

Fax

(512) 522-4483

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Group practices

Central Texas Community Health CentersGroup PAC ID 5395802151, 165 clinicians

Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Oliver Street 5.01(a) Inc.

  • Dermatology Physician
  • Dallas, TX
  • NPI 1457695413
  Medicare reassignment Care Compare group NPD
• Central Texas Community Health Centers

  • Family Medicine Physician
  • Austin, TX
  • NPI 1427882091
  Medicare reassignment Care Compare group
• Dermatology Associates

  • Dermatology Physician
  • Houston, TX
  • NPI 1356523039
  NPD (past)

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502150400000",
    "number": "1801816715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 WYOMING SPGS",
            "address_2": "SUITE 300",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814303",
            "telephone_number": "512-910-8800",
            "fax_number": "512-522-4483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 WYOMING SPGS",
            "address_2": "SUITE 300",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814303",
            "telephone_number": "512-910-8800",
            "fax_number": "512-522-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECKHAM",
        "first_name": "RUSSELL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2017-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102201303",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "P5120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shellie Pearce, LCDC
• Emily Pearcy, LCSW
• Taylor Daniel Peardon
• Jessika M Pecina
• Elizabeth Lynn Ulrich Peckham, D.O.
• Pediatric Center of Round Rock
• Terry Scott Peery, DO
• Daniel Pelaez
• Candice Roseanne Pellegrino, M.P.A.C., P.A.-C
• Jennifer Peloquin, LMFT

• Dermatology Physician in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2017; 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.