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GRAND LAKE PRIMARY CARE
NPI 1316092182
Family Medicine in Grove, OK

Active since January 24, 2007
900 E 13TH ST, SUITE 104, GROVE, OK 74344(918) 786-3100(918) 786-3108 Get Directions Write a Review

NPPES record last updated: November 11, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Grand Lake Primary Care NPPES

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

GRAND LAKE PRIMARY CARE (NPI 1316092182) is a healthcare organization registered as a family medicine in Grove, Oklahoma and active in the NPI registry since January 2007. The organization lists Renee Jean Russell, Provider, as its authorized official.

NPPES Registry Identity

NPI1316092182
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameRENEE J RUSSELL MD INC
Location Address900 E 13TH ST, SUITE 104Grove, OK 74344-2975
Mailing Address1110 Neo LoopGrove, OK 74344-6046 · (918) 786-3100 · Fax (918) 786-3108
Phone(918) 786-3100
Fax(918) 786-3108
Organization SubpartNo
Authorized OfficialRenee Jean RussellProvider · (918) 786-3100
Enumeration DateJanuary 24, 2007
Last NPPES UpdateNovember 11, 2016
✔ NPI 1316092182 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in OK · 22021
Definition
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.
900 E 13TH ST, Grove, OK 74344
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Other Names 1

Doing Business AsGrand Lake Primary Care

Other Identifiers 4

Medicare ID-Type Unspecified900522115OK · Medicare Group #
Medicare ID-Type Unspecified249321002OK · Medicare Individual #
Medicare UPINH73424OK
Medicaid100017290DOK

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Grand Lake Primary Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Grand Lake Primary Care, which bills Medicare for the services this clinician delivers.

Clinician (1)

Renee Russell, MD
Family Practice
NPI 1245286921
1110 NEO LOOP
Grove, OK 74344
(918) 786-3100
✔ PECOS✔ Accepts Medicare0.4 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Renee J Russell MD Inc's NPI number?

The NPI number for Renee J Russell MD Inc is 1316092182. It was assigned to this organization in the NPPES registry on January 24, 2007. The provider is doing business as Grand Lake Primary Care.

Where is Renee J Russell MD Inc located?

Renee J Russell MD Inc is located at 900 E 13th St Suite 104, Grove, OK 74344. The listed phone number is (918) 786-3100.

What is Renee J Russell MD Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Renee J Russell MD Inc enrolled in Medicare?

Yes. Renee J Russell MD Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Renee J Russell MD Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Renee J Russell MD Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Renee J Russell MD Inc was last updated on November 11, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.