Active NPI
Russell Rolison Mann, MA
- Contractor
- Flagstaff, AZ
National Provider Identifier
1851470025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 3807
- Practice address
- 59 Pine del St
Flagstaff, AZ 86001-9603 - Phone
- (928) 774-5669
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 3807 | AZ | Primary |
Addresses
Primary practice location
59 Pine del St
Flagstaff, AZ 86001-9603
Mailing address
59 Pine del St
Flagstaff, AZ 86001-9603
Phone (928) 774-5669
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 711714 | Other | AZ | AHCCCS |
| 3807 | Other | AZ | AZDES PROVIDER FACILITY I |
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3807 | AZ | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851470025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "59 PINE DEL ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860019603",
"telephone_number": "928-774-5669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 PINE DEL ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860019603",
"telephone_number": "928-774-5669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANN",
"first_name": "RUSSELL",
"middle_name": "ROLISON",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "AZ",
"license": "3807",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "711714",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZDES PROVIDER FACILITY I",
"identifier": "3807",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.