Russell J Tanner, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA02552 Issued in TX

Practice address

808 Woodrow Wilson Ray Cir
Bridgeport, TX 76426-2061

Phone

(940) 683-2297

Fax

(940) 683-2984

NPI assigned

May 16, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rusty.tanner@dardp-tx.direct.office.nextgen.com

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.

• Be Well Primary Care Medicine PLLC

  • Primary Care Clinic/Center
  • Fort Worth, TX
  • NPI 1447774344
  Medicare reassignment NPD
• Jon W Copeland DO PA

  • Family Medicine Physician
  • Bridgeport, TX
  • NPI 1649304486
  NPD

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1871544486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 WOODROW WILSON RAY CIR",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262061",
            "telephone_number": "940-683-2297",
            "fax_number": "940-683-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 WOODROW WILSON RAY CIR",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262061",
            "telephone_number": "940-683-2297",
            "fax_number": "940-683-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "RUSSELL",
        "middle_name": "J",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA02552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southwest Healthcare Ventures (Cambio Life Recovery Center)
• Michaelyn Stainton
• Steve Longacre M.D. PA
• Taloni Rae Chrislynn Stone-Saturnio, PTA
• Mihir Umesh Talati, MD
• Chandra Renee Vanvacter, RPH
• Virtue Medical Group, LLC
• Virtue Medical PA, PLLC
• Virtue Medical Physical Therapy, PLLC
• Walgreen Co (Walgreens #21463)

• Medical Physician Assistant in Bridgeport, TX
• Providers in Bridgeport, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.