Active NPI
Russell Worthy Cameron, PT
- Physical Therapist
- Clovis, NM
National Provider Identifier
1881769438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3292
- Practice address
- 1600 Sutter PL
Clovis, NM 88101-4611 - Phone
- (505) 769-4490
- Fax
- (505) 935-0011
- NPI assigned
- Nov 21, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3292 | NM | Primary |
Addresses
Primary practice location
1600 Sutter PL
Clovis, NM 88101-4611
Mailing address
432 Monticello Parkway Dr
Portales, NM 88130-9273
Phone (505) 226-3030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00637734 | Medicaid | NM |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3292 | NM | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clovis Municipal Schools | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Clovis, NM
- NPI 1174662316
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881769438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "432 MONTICELLO PARKWAY DR",
"city": "PORTALES",
"state": "NM",
"postal_code": "881309273",
"telephone_number": "505-226-3030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SUTTER PL",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014611",
"telephone_number": "505-769-4490",
"fax_number": "505-935-0011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMERON",
"first_name": "RUSSELL",
"middle_name": "WORTHY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "3292",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00637734",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.