Active NPI
Russell S Vanderwilde, M.D.
- Orthopaedic Surgery Physician
- Spokane, WA
National Provider Identifier
1871562967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- MD00030742
- Practice address
- 601 W 5TH Ave
Suite 400
Spokane, WA 99204-2715 - Phone
- (509) 344-2663
- Fax
- (509) 624-9179
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | MD00030742 | WA | Primary |
Addresses
Primary practice location
601 W 5TH Ave
Suite 400
Spokane, WA 99204-2715
Mailing address
601 W 5TH Ave
Suite 400
Spokane, WA 99204-2715
Phone (509) 344-2663
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083047 | Medicaid | WA | |
| 200016187 | Other | WA | RR MEDICARE |
| K6484 | Other | ID | BLUE CROSS OF IDAHO |
| 3780VA | Other | WA | ASURIS NW HEALTH |
| 8919653 | Other | WA | CRIME VICTIMS |
| 3283 | Other | WA | GROUP HEALTH NW |
| 000010002357 | Other | ID | REGENCE BS OF IDAHO |
| 42091 | Other | WA | DEPT OF LABOR & INDUSTRIE |
| 003297000 | Medicaid | ID | |
| 379109600 | Other | WA | OWCP |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- russell.vanderwilde.1@16598.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205193600000",
"number": "1871562967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W 5TH AVE",
"address_2": "SUITE 400",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042715",
"telephone_number": "509-344-2663",
"fax_number": "509-624-9179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 W 5TH AVE",
"address_2": "SUITE 400",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042715",
"telephone_number": "509-344-2663",
"fax_number": "509-624-9179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERWILDE",
"first_name": "RUSSELL",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2008-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "WA",
"license": "MD00030742",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1083047",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "200016187",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "K6484",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASURIS NW HEALTH",
"identifier": "3780VA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8919653",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH NW",
"identifier": "3283",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BS OF IDAHO",
"identifier": "000010002357",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR & INDUSTRIE",
"identifier": "42091",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003297000",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "379109600",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.