Individual provider Active NPI

Jared T Russell

  • Certified Registered Nurse Anesthetist
  • Charleston, WV
National Provider Identifier
1992503718
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
123379 Issued in WV
Practice address
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone
(304) 388-5432
NPI assigned
Mar 6, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 123379 WV Primary

Addresses

Primary practice location

3200 Maccorkle Ave SE
Charleston, WV 25304-1227

Mailing address

8 Nancy LN
Barboursville, WV 25504-1164
Phone (304) 991-7711

Other practice location 1

1220 Lee St E
Charleston, WV 25301-1863
Phone (304) 388-1800

Other practice location 2

1306 Kanawha Blvd E
Charleston, WV 25301-3001
Phone (304) 343-4371

Other practice location 3

800 Pennsylvania Ave
Charleston, WV 25302-3351
Phone (304) 388-5432

Other practice location 4

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250619000266 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678084274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-7823

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
123379WVMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc CurrentSince Jul 1, 2025 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jul 1, 2025 Accepting new patients

Locations

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

1306 Kanawha Blvd E
Charleston, WV 25301
Phone (304) 343-4371

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

Organizations & group practices 2

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 11

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": "1741219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1992503718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 NANCY LN",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255041164",
            "telephone_number": "304-991-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1220 Lee St E",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011863",
            "country_code": "US",
            "telephone_number": "304-388-1800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1306 Kanawha Blvd E",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253013001",
            "country_code": "US",
            "telephone_number": "304-343-4371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253023351",
            "country_code": "US",
            "telephone_number": "304-388-5432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "501 Morris St",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011326",
            "country_code": "US",
            "telephone_number": "304-388-5432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JARED",
        "middle_name": "T",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "123379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.