Andrew Martin Russell, PA-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MA061552 Issued in PA

Practice address

200 Municipal Dr
Thorndale, PA 19372-1058

Phone

(610) 383-6300

NPI assigned

Jun 24, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renew Wound Care of Pennsylvania LLC

  • Internal Medicine Physician
  • Wyncote, PA
  • NPI 1194442640
  Medicare reassignment

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1881210946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MUNICIPAL DR",
            "city": "THORNDALE",
            "state": "PA",
            "postal_code": "193721058",
            "telephone_number": "610-383-6300",
            "fax_number": "610-383-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MUNICIPAL DR",
            "city": "THORNDALE",
            "state": "PA",
            "postal_code": "193721058",
            "telephone_number": "610-383-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ANDREW",
        "middle_name": "MARTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MA061552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EClinicalWorks",
            "affiliation": "N",
            "address_1": "200 Municipal Dr",
            "city": "Thorndale",
            "state": "PA",
            "country_code": "US",
            "postal_code": "193721058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rajesh Reddy, D.O.
• Renal Treatment Centers Northeast Inc (Thorndale Dialysis)
• Richard E Deforno DMD PC (Thorndale Dental Associates)
• Rite Medical Care PC
• Julia Nicole Rose
• Michael P Sabadish, M.D.
• Gia Scavo, O.D.
• Robert E. Schmidt, M.D.
• Christopher J Schreier, D.O.
• Lindsay Sears, LCSW

• Family Medicine Physician in Thorndale, PA
• Providers in Thorndale, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.