DR. STEPHANIE JANE RUSS (NPI# 1629239355) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629239355 |
| Entity Type | Individual |
| Full Name | DR. STEPHANIE JANE RUSS |
| Other Name | DR. STEPHANIE JANE WILSON |
| Credential | DO |
| Practice Address |
1251 S Huntzinger Blvd Suite 100 Pendleton IN 46064 |
| Mailing Address |
6626 E. 75th Street Suite 500 Indianapolis IN 46250-2890 |
| Practice Telephone | 7652984567 |
| Practice Fax Number | 7652984568 |
| Mailing Telephone | 7652984569 |
| Mailing Fax Number | 7652984568 |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-09-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 11014474A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200975760 | 05 | |
| IN | RAILROAD MEDICARE | P01430098 | 01 |
| Street Address |
1251 S HUNTZINGER BLVD SUITE 100 |
| City | PENDLETON |
| State | IN |
| Zip Code | 46064 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912214727 | Classic Sleepcare, LLC | Durable Medical Equipment & Medical Supplies | 138 West State Street, Suite #4, Pendleton, IN 46064 | 2010-09-01 |
| 1003004219 | Hamilton-madison, Inc. | Durable Medical Equipment & Medical Supplies | 105 1/2 E. State Street, Pendleton, IN 46064 | 2007-10-12 |
| 1518019637 | Pendleton Emergency Ambulance Inc | Ambulance | 100 S Broadway, Pendleton, IN 46064 | 2007-01-17 |
| 1487755716 | Anna Marie Tallant | Counselor | 131 N Pendleton Ave, Suite A, Pendleton, IN 46064 | 2006-09-26 |
| 1336242700 | Jennifer A Neise | Dentist | 3132 W. State Road 38, Pendleton, IN 46064 | 2006-09-07 |
| 1366900599 | Megan Daberko | Registered Nurse | 1251 Huntzinger Blvd Ste 100, Pendleton, IN 46064 | 2019-03-06 |
| 1821594672 | Jean Castro | Registered Nurse | 1251 Huntzinger Blvd Ste 100, Pendleton, IN 46064 | 2018-04-02 |
| 1013002310 | Kenneth U Lau | Dentist | 210 East Water Street, Pendleton, IN 46064 | 2006-10-03 |
| 1912955832 | Indiana Tmj Treatment Center | Dentist | 210 East Water Street, Pendleton, IN 46064-0206 | 2006-05-04 |
| 1962496430 | Megan Noel Jones | Optometrist | 120 E State St, Pendleton, IN 46064-1027 | 2005-09-09 |
| Find all providers in zip 46064 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083262703 | Praxis Medical Group Inc | Family Medicine | 2450 Sw Perkins Avenue, Pendleton, OR 97801 | 2019-08-27 |
| 1649449166 | Manpreet Multani | Family Medicine | 3041 W Us Highway 36, Pendleton, IN 46064-9280 | 2008-02-28 |
| 1861675456 | Anmed Health | Family Medicine | 1005 Meehan Way, Pendleton, SC 29670-1824 | 2007-12-06 |
| 1841207255 | Eric C Jones | Family Medicine | 138 W State St, Pendleton, IN 46064-1034 | 2006-08-01 |
| 1346261971 | Community Hospitals of Indiana Inc | Family Medicine | 1251 Huntzinger Blvd, Suite 100, Pendleton, IN 46064-9493 | 2006-07-21 |
| 1790705259 | Pendleton Family Practice, LLC | Family Medicine | 101 Shirley St, Pendleton, SC 29670-1824 | 2006-07-20 |
| 1104846351 | Robert G Johnson Jr. | Family Medicine | 2450 Sw Perkins Ave, Pendleton, OR 97801 | 2006-07-20 |
| 1548299233 | Gary A Wright | Family Medicine | 75 Village Dr, Pendleton, IN 46064-8960 | 2006-07-03 |
| 1619911757 | Traci A Anderson | Family Medicine | 1251 Huntzinger Blvd Ste 100, Pendleton, IN 46064-9404 | 2006-06-16 |
| 1265473813 | Mark D Walsh | Family Medicine | 7611 Hwy 76, Suite C, Pendleton, SC 29670 | 2006-06-08 |
| Find all providers in PENDLETON | ||||
Please comment or provide details below to improve the information on DR. STEPHANIE JANE RUSS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.