NPIMap

Individual provider Active NPI

Denver Alan Russell, PA

  • Physician Assistant
  • Galion, OH
National Provider Identifier
1871967562
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.004618RX Issued in OH
Practice address
269 Portland Way S
Galion, OH 44833-2312
Phone
(419) 468-4841
NPI assigned
Nov 18, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 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 50.004618RX OH Primary

Addresses

Primary practice location

269 Portland Way S
Galion, OH 44833-2312

Mailing address

700 N Columbus St
Crestline, OH 44827-1455

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address drussell536678@direct.osumc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20160620000302 OH Practitioner - Physician Assistant 6901197110 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Central Ohio Family Care Center IncGroup PAC ID 3274437082, 194 clinicians

Practice addresses (Care Compare)

269 Portland Way S
Galion, OH 44833-2312
Phone (419) 468-4841

2981 W 4TH St
Ontario, OH 44906-1267
Phone (419) 468-0505

715 Richland Mall
Ontario, OH 44906-3802
Phone (567) 307-7557

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.004618RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Toledo Physicians LLC Physician Assistant Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: drussell536678@direct.osumc.edu

Organizations & group practices 5

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 5

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": "1447804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1871967562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N COLUMBUS ST",
            "city": "CRESTLINE",
            "state": "OH",
            "postal_code": "448271455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 PORTLAND WAY S",
            "city": "GALION",
            "state": "OH",
            "postal_code": "448332312",
            "telephone_number": "419-468-4841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "DENVER",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-18",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004618RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drussell536678@direct.osumc.edu",
            "affiliation": "N",
            "address_1": "269 Portland Way S",
            "city": "Galion",
            "state": "OH",
            "country_code": "US",
            "postal_code": "448332312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Galion, OH

Sources for this page

Verify at the official NPI Registry.