Active NPI
Jeffrey Kirk Russell, PA-C
- Physician Assistant
- Port Angeles, WA
National Provider Identifier
1801871421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA60898671
- Practice address
- 907 Georgiana St
Port Angeles, WA 98362-3911 - Phone
- (360) 565-0999
- Fax
- (360) 565-9251
- NPI assigned
- Dec 7, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA60898671 | WA | Primary |
Addresses
Primary practice location
907 Georgiana St
Port Angeles, WA 98362-3911
Mailing address
PO Box 850
Port Angeles, WA 98362-0146
Phone (360) 417-7111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central California Faculty Medical Group, Inc. | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1992742852
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583884800000",
"number": "1801871421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 850",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983620146",
"telephone_number": "360-417-7111",
"fax_number": "360-417-7342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "907 GEORGIANA ST",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983623911",
"telephone_number": "360-565-0999",
"fax_number": "360-565-9251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JEFFREY",
"middle_name": "KIRK",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-07",
"last_updated": "2020-03-11",
"certification_date": "2020-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA60898671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Angeles, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.