Russel Donnan Smith, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

2005012199 Issued in MO

Practice address

3567 NE Tillamook St
Portland, OR 97212-5158

Phone

(773) 810-9072

NPI assigned

Dec 15, 2005

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Advanced Radiology Consultants SC

  • Diagnostic Radiology Physician
  • Park Ridge, IL
  • NPI 1750380119
  NPD (past)
• University Radiology Associates, LLP

  • Diagnostic Radiology Physician
  • Syracuse, NY
  • NPI 1215978184
  NPD (past)

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1962488585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3567 NE TILLAMOOK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125158",
            "telephone_number": "773-810-9072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3567 NE TILLAMOOK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125158",
            "telephone_number": "773-810-9072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RUSSEL",
        "middle_name": "DONNAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2005012199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00861014",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rene Smith
• Robert Smith, DMD
• Robert Keith Smith, MD
• Robin Danielson Smith
• Ronald C Smith, PA-C, MMSC
• Saleemah Wajeedah Smith, PA-C
• Samantha Smith
• Sandra Kaye Smith
• Sara Jean Smith
• Sarah Smith

• Diagnostic Radiology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Diagnostic Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; 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.