Individual provider Active NPI

Matthew Franklin Russell, MD

  • Emergency Medicine Physician
  • Mount Vernon, WA
National Provider Identifier
1932138385
Registry record updated Feb 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Practice address
1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone
(360) 428-2166
Fax
(360) 428-2457
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X WA Primary

Addresses

Primary practice location

1415 E Kincaid St
Mount Vernon, WA 98274-4126

Mailing address

505 S 336TH St
Suite # 600
Federal Way, WA 98003-6328
Phone (360) 428-2166

Other identifiers 3

IdentifierTypeStateIssuer
0182293OtherWALIWA
7458RUOtherWABSWA
8283186MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040322001510 WA Practitioner - Emergency Medicine 5597656397 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD000039841WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Jan 1, 2004 Accepting new patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Oct 27, 2017 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Jan 1, 2004 Accepting new patients
Northwest Physician Associates, Apc Emergency Medicine Past Accepting new patients

Locations

330 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2133

2901 Squalicum Pkwy
Bellingham, WA 98225
Phone (360) 734-5400

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

2000 Hospital Dr
Sedro Woolley, WA 98284
Phone (360) 856-6021

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: mrussell438161@direct.peacehealth.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203638400000",
    "number": "1932138385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S 336TH ST",
            "address_2": "SUITE # 600",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036328",
            "telephone_number": "360-428-2166",
            "fax_number": "253-838-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-428-2166",
            "fax_number": "360-428-2457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MATTHEW",
        "middle_name": "FRANKLIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIWA",
            "identifier": "0182293",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSWA",
            "identifier": "7458RU",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8283186",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.