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RUSSELL BOSTON
NPI 1124821616
Student in an Organized Health Care Education/Training Program in Charlotte, NC

Active since March 31, 2025PECOS Enrolled
1350 S KINGS DR FL 3, CHARLOTTE, NC 28207(704) 446-1242(704) 446-1241 Get Directions Write a Review

NPPES record last updated: May 16, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 16, 2026, Mar 31, 2025 (2 updates tracked since 2025).

About Russell Boston NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RUSSELL BOSTON (NPI 1124821616) is an individual student in an organized health care education/training program in Charlotte, North Carolina and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124821616
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameRUSSELL BOSTON
Location Address1350 S KINGS DR FL 3Charlotte, NC 28207-2134
Mailing Address1350 S Kings Dr Fl 3Charlotte, NC 28207-2134 · (704) 446-1242 · Fax (704) 446-1241
Phone(704) 446-1242
Fax(704) 446-1241
Sole ProprietorNo
Enumeration DateMarch 31, 2025
Last NPPES UpdateMay 16, 20262 updates tracked since enumeration
NPPES CertifiedMay 16, 2026
✔ NPI 1124821616 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1350 S KINGS DR FL 3, Charlotte, NC 28207
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Russell Boston is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM DAVID LAIDIG
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
MARYAM ZOABI DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
ELAINE PATEL MD
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
DONALD ELLIS DEEP DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
PRIYANKA MOHANTY DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
VICTORIA MAE KONIUK DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
SARINA SHRESTHA MD
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
CAROLINE HORNE
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Russell Boston's NPI number?

The NPI number for Russell Boston is 1124821616. It was assigned to this individual provider in the NPPES registry on March 31, 2025.

Where is Russell Boston located?

Russell Boston practices at 1350 S Kings Dr Fl 3, Charlotte, NC 28207. The listed phone number is (704) 446-1242.

What is Russell Boston's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Russell Boston enrolled in Medicare?

Yes. Russell Boston is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Russell Boston was last updated on May 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.