NPIMap

Individual provider Active NPI

Ryan Russell, DO

  • Family Medicine Physician
  • La Grange, KY
National Provider Identifier
1841751187
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TP787 Issued in KY
Practice address
1019 Commerce Pkwy
La Grange, KY 40031-8779
Phone
(502) 225-9098
Fax
(502) 225-9851
NPI assigned
Mar 28, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X TP787 KY Primary

Addresses

Primary practice location

1019 Commerce Pkwy
La Grange, KY 40031-8779

Mailing address

127 North St
Batavia, NY 14020-1631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220630003066 KY Practitioner - Family Practice 0446630826 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

1019 Commerce Pkwy
La Grange, KY 40031-8779
Phone (502) 225-9098

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
TP787KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc Multi-Specialty CurrentSince Jun 10, 2022 Accepting new patients
Baptist Health Medical Group Inc Multi-Specialty CurrentSince Jun 10, 2022 Accepting new patients

Locations

1019 Commerce Pkwy
Lagrange, KY 40031
Phone (502) 225-9098

5200 Commerce Crossings Dr
Fl 3
Louisville, KY 40229
Phone (502) 253-4924

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

Organizations & group practices 2

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1841751187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 NORTH ST",
            "city": "BATAVIA",
            "state": "NY",
            "postal_code": "140201631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 COMMERCE PKWY",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400318779",
            "telephone_number": "502-225-9098",
            "fax_number": "502-225-9851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "RYAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-28",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "TP787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange, KY

Sources for this page

Verify at the official NPI Registry.