NPIMap

Individual provider Active NPI

Kimberly Muro Russell, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1851775407
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA057504 Issued in PA
Practice address
3509 N Broad St
Philadelphia, PA 19140-4105
Phone
(215) 707-8484
Fax
(215) 707-3946
NPI assigned
Jul 14, 2015
Last updated
Oct 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA057504 PA Primary

Addresses

Primary practice location

3509 N Broad St
Philadelphia, PA 19140-4105

Mailing address

907 McKean St
Philadelphia, PA 19148-2326
Phone (267) 247-6013

Other practice location 1

3401 N Broad St
Suite C-100
Philadelphia, PA 19140-5103
Phone (215) 707-3601

Other names 1

  • Mrs. Kimberly Muro Russell Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20160425001701 PA Practitioner - Physician Assistant 9931408093 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2301 S Broad St
Philadelphia, PA 19148-3542

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 1, 2019 Accepting new patients
Einstein Practice Plan Inc CurrentSince Nov 15, 2021 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Jul 1, 2025 Accepting new patients
Einstein Practice Plan Inc CurrentSince Nov 15, 2021 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Mar 1, 2019 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
Methodist Associates in Healthcare, Inc Past Accepting new patients

Locations

1101 Chestnut St
Ste 1100
Philadelphia, PA 19107

1101 Market St
Fl 19
Philadelphia, PA 19107
Phone (215) 481-6836

2301 S Broad St
Ste 102
Philadelphia, PA 19148
Phone (215) 952-5175

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3401 N Broad St
Ste C100
Philadelphia, PA 19140
Phone (215) 707-3601

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

7500 Central Ave
Philadelphia, PA 19111
Phone (215) 214-4100

9880 Bustleton Ave
Ste 205
Philadelphia, PA 19115
Phone (215) 676-2222

Organizations & group practices 12

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1851775407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 MCKEAN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191482326",
            "telephone_number": "267-247-6013",
            "fax_number": "215-707-9131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-8484",
            "fax_number": "215-707-3946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 N Broad St",
            "address_2": "Suite C-100",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-3601",
            "fax_number": "215-707-1576",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KIMBERLY",
        "middle_name": "MURO",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-14",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA057504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MURO RUSSELL",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.