NPIMap

Individual provider Active NPI

Christopher Thomas Russell, MD

  • Diagnostic Radiology Physician
  • Cape Girardeau, MO
National Provider Identifier
1902812613
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2005014833 Issued in MO
Practice address
70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone
(573) 334-6071
Fax
(573) 334-4739
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2005014833 MO Primary

Addresses

Primary practice location

70 Doctors Park
Cape Girardeau, MO 63703-4928

Mailing address

70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone (573) 334-6071

Other identifiers 6

IdentifierTypeStateIssuer
430954380CAPOtherMERCY HEALTH PLAN
185214OtherMOMO BLUE CROSS BLUE SHIELD
716349OtherHEALTHLINK
207361304MedicaidMO
036-113584OtherILIL BLUE CROSS BLUE SHIELD
063896OtherHEALTH ALLIANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL, MT, KY4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20051031001009 MO Practitioner - Diagnostic Radiology 7315917986 Reassigns benefits to 3 organizations
I20051114000651 IL Practitioner - Diagnostic Radiology 7315917986 Reassigns benefits to 1 organization
I20131030001532 MT Practitioner - Diagnostic Radiology 7315917986 Reassigns benefits to 1 organization
I20230508002488 KY Practitioner - Diagnostic Radiology 7315917986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical Branch at Galveston, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Radiology Group PCGroup PAC ID 9830093236, 54 clinicians
Mercy Hospital PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

1200 N One Mile Rd
Dexter, MO 63841-1000
Phone (573) 614-1901

1530 Lone Oak Rd
Paducah, KY 42003-7901
Phone (270) 444-2444

211 Saint Francis Dr
Cape Girardeau, MO 63703-5049
Phone (573) 331-3000

2760 Bobtail Horse Rd
Big Sky, MT 59716-1910
Phone (573) 334-6071

405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721

434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536

650 S Mt Auburn Rd
100 Southeast Breast Health
Cape Girardeau, MO 63703-3435
Phone (573) 335-6671

70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone (573) 334-6071

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183
  • Mercy Health - Lourdes Hospital Hospital, Paducah, KY, CCN 180102
  • Poplar Bluff Regional Medical Center Hospital, Poplar Bluff, MO, CCN 260119
  • Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
  • Herrin Hospital Hospital, Herrin, IL, CCN 140011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2005014833MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospital Perry Diagnostic Radiology Current Accepting new patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Lufkin Radiology Associates Diagnostic Radiology PastSince Aug 30, 2020 Accepting new patients

Locations

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

Organizations & group practices 8

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.

Hospital & facility affiliations 7

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1902812613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 DOCTORS PARK",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034928",
            "telephone_number": "573-334-6071",
            "fax_number": "573-334-4739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 DOCTORS PARK",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034928",
            "telephone_number": "573-334-6071",
            "fax_number": "573-334-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CHRISTOPHER",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2005014833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH PLAN",
            "identifier": "430954380CAP",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO BLUE CROSS BLUE SHIELD",
            "identifier": "185214",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "716349",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207361304",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BLUE CROSS BLUE SHIELD",
            "identifier": "036-113584",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "063896",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.