Active NPI
George R Russell, MD
- Dermatology Physician
- Boulder, CO
National Provider Identifier
1932178241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 17600
- Practice address
- 1000 Alpine Ave
#50
Boulder, CO 80304-3409 - Phone
- (303) 444-4864
- Fax
- (303) 444-4865
- NPI assigned
- Mar 17, 2006
- 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 17600 | CO | Primary |
Addresses
Primary practice location
1000 Alpine Ave
#50
Boulder, CO 80304-3409
Mailing address
PO Box 18058
Boulder, CO 80308-1058
Phone (303) 444-4864
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 840721166001 | Other | CO | ROCKY MOUNTAIN |
| RU78831 | Other | CO | BLUE CROSS |
| 84072116601 | Other | CO | PACIFICARE |
| 01176007 | Medicaid | CO | |
| 4009828 | Other | CO | AETNA |
| 667695 | Other | CO | BCBS FEDERAL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17600 | CO | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216944000000",
"number": "1932178241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18058",
"city": "BOULDER",
"state": "CO",
"postal_code": "803081058",
"telephone_number": "303-444-4864",
"fax_number": "303-444-4865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 ALPINE AVE",
"address_2": "#50",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043409",
"telephone_number": "303-444-4864",
"fax_number": "303-444-4865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "GEORGE",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-17",
"last_updated": "2008-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CO",
"license": "17600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ROCKY MOUNTAIN",
"identifier": "840721166001",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "RU78831",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE",
"identifier": "84072116601",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01176007",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4009828",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS FEDERAL",
"identifier": "667695",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.