Russell W Brown, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036081556 Issued in IL

Practice address

405 Rushing Dr
Herrin, IL 62948-3730

Phone

(618) 993-3300

Fax

(618) 997-6626

NPI assigned

Aug 18, 2006

Last updated

Nov 3, 2011By 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

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320278400000",
    "number": "1891809810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1105",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462061105",
            "telephone_number": "618-549-5361",
            "fax_number": "618-529-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483730",
            "telephone_number": "618-993-3300",
            "fax_number": "618-997-6626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "RUSSELL",
        "middle_name": "W",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2011-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036081556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "174143",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036081556",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "043448",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "10019630",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080129117",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Laine Brazis, DPM
• Robert Judson Brewer, M.D.
• Daniel R Brown
• Jennifer E Brown
• Patrick David Brown, LCSW
• Treg D Brown, MD
• Amber Brumley, FNP-C
• Jesse Paul Bueza, PA-C
• Sarah Burdick
• Elizabeth Ann Bush, AUD

• Family Medicine Physician in Herrin, IL
• Providers in Herrin, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.