Russell W McCalley, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36176 Issued in CA

Practice address

4320 Genesee Ave
Suite 201
San Diego, CA 92117-4900

Phone

(858) 560-1996

NPI assigned

Jun 3, 2006

Sex

Male

Sole proprietor

Yes

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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 12, 2016 through May 12, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215475200000",
    "number": "1831137645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 GENESEE AVE",
            "address_2": "SUITE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921174900",
            "telephone_number": "858-560-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 GENESEE AVE",
            "address_2": "SUITE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921174900",
            "telephone_number": "858-560-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALLEY",
        "first_name": "RUSSELL",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2008-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace McCall
• Kayleigh McCall, BS
• Meredith McCall
• Michael McCall
• Stacey Leigh McCall
• Danielle Debussey McCallion, FNP-C
• Joseph John Loughrey McCallum, DO
• Vicki Lynn McCalmont, MS, NP
• Anne W McCammon, M.D.
• Cambria Lee McCammon

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.

Verify at the official NPI Registry.