NPIMap

Individual provider Active NPI

Jeffrey Lynn Russell, DPM

  • Podiatrist
  • Watonga, OK
National Provider Identifier
1942309034
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO2966 Issued in FL
Practice address
RR 1 Box 34-a
Watonga, OK 73772-9706
Phone
(580) 623-4991
Fax
(580) 623-5490
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO2966 FL Primary

Addresses

Primary practice location

RR 1 Box 34-a
Watonga, OK 73772-9706

Mailing address

2001 S Country Club Rd
Apt. #701
El Reno, OK 73036-5689
Phone (580) 623-4991

Other identifiers 1

IdentifierTypeStateIssuer
9102966MedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050926000755 TX Practitioner - Podiatry 5294769568 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anadarko Indian Health CenterGroup PAC ID 7719931559, 47 clinicians

Practice addresses (Care Compare)

201 E Parker McKenzie Dr
Anadarko, OK 73005-5009
Phone (405) 247-7900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue62
Removal of nail tissue120
Removal or shaving of skin growth59

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO2966FLMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Anadarko Indian Health Center CurrentSince Jul 10, 2013 Accepting new patients
Lawton Indian Hospital CurrentSince Jul 10, 2013 Accepting new patients
Carnegie Indian Health Center CurrentSince Jul 10, 2013 Accepting new patients
U S Health Dept of Health & Human Services Past Accepting new patients
Watonga Indian Health Center Past Accepting new patients
Clinton Indian Health Center Past Accepting new patients
U S Health Dept of Health & Human Services Past Accepting new patients
Usphs Indian Health Service Past Accepting new patients

Locations

201 E Parker McKenzie Dr
Anadarko, OK 73005
Phone (405) 247-7900

212 E 4th St
Carnegie, OK 73015
Phone (580) 654-1100

10321 N 2274 Rd
Clinton, OK 73601
Phone (580) 331-3300

1801 Parkview Dr
El Reno, OK 73036
Phone (405) 234-5600

1515 NE Lawrie Tatum Rd
Lawton, OK 73507
Phone (580) 353-0350

1305 S Clarence Nash Blvd
Watonga, OK 73772
Phone (580) 623-4991

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 6

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1942309034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S COUNTRY CLUB RD",
            "address_2": "APT. #701",
            "city": "EL RENO",
            "state": "OK",
            "postal_code": "730365689",
            "telephone_number": "580-623-4991",
            "fax_number": "580-623-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 1 BOX 34-A",
            "city": "WATONGA",
            "state": "OK",
            "postal_code": "737729706",
            "telephone_number": "580-623-4991",
            "fax_number": "580-623-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JEFFREY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO2966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9102966",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watonga, OK

Sources for this page

Verify at the official NPI Registry.