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JACOB ROBERT RUSSELL DO
NPI 1417318361
Emergency Medicine in Surprise, AZ

Active since March 18, 2016PECOS EnrolledAccepts Medicare Assignment
16815 W BELL RD, SURPRISE, AZ 85374(602) 833-6900 Get Directions Write a Review

NPPES record last updated: July 8, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 8, 2022, Apr 23, 2021, Sep 27, 2019 and 1 more (4 updates tracked since 2016).

About Jacob Robert Russell Do NPPES

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

JACOB ROBERT RUSSELL DO (NPI 1417318361) is an individual emergency medicine provider in Surprise, Arizona, licensed in Arizona (008645) and active in the NPI registry since March 2016. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Michigan State University College Of Osteopathic Medicine (2016).

NPPES Registry Identity

NPI1417318361
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameJACOB ROBERT RUSSELLCredential: DO
Location Address16815 W BELL RDSurprise, AZ 85374-2101
Mailing Address294 Summar DrJackson, TN 38301-3915 · (731) 265-8220
Phone(602) 833-6900
Sole ProprietorNo
Medical School CMSMichigan State University College Of Osteopathic MedicineGraduated 2016
Enumeration DateMarch 18, 2016
Last NPPES UpdateJuly 8, 20224 updates tracked since enumeration
NPPES CertifiedJuly 8, 2022
✔ NPI 1417318361 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in AZ · 008645
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Also ListedEmergency Medicine · Emergency Medical ServicesTaxonomy 207PE0004X · License 3749 (MI)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
16815 W BELL RD, Surprise, AZ 85374
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Secondary Practice Locations 3

Location 115855 19 Mile RdClinton Township, MI 48038-3504 · Phone (586) 263-2300
Location 2294 Summar DrJackson, TN 38301-3915 · Phone (731) 265-8220
Location 3620 Skyline DrJackson, TN 38301 · Phone (731) 541-5000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacob Robert Russell Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8123312139
PECOS Enrollment IDI20201102000259
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Jacob Russell reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Emergency Group Of Arizona Professional Corporation
20 mi
Emergency Medicine
2000 W BETHANY HOME RD
Phoenix, AZ 85015
  • Reassigned Medicare billing, Arizona enrollment
  • 260 clinicians in this Medicare group
NPI 1215275433 (925) 924-1600
Arizona Acute Medical Services 1 PC
25 mi
Hospitalist
1930 E THOMAS RD
Phoenix, AZ 85016
  • Reassigned Medicare billing, Arizona enrollment
  • 302 clinicians in this Medicare group
NPI 1154860674 (602) 532-1000

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

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
159 services154 patients
Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
120 services117 patients
Emergency department visit with low level of medical decision making 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
57 services57 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
51 services47 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
15 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85374 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

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

DESPINA LOZEVSKI PA-C
Physician Assistant
16815 W BELL RD
SURPRISE, AZ 85374
Maricopa County (623) 244-2400

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 Jacob Russell's NPI number?

The NPI number for Jacob Russell is 1417318361. It was assigned to this individual provider in the NPPES registry on March 18, 2016.

Where is Jacob Russell located?

Jacob Russell practices at 16815 W Bell Rd, Surprise, AZ 85374. The listed phone number is (602) 833-6900.

What is Jacob Russell's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Jacob Russell enrolled in Medicare?

Yes. Jacob Russell is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jacob Russell's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Russell reassigns Medicare benefits to 2 organizations: Emergency Group Of Arizona Professional Corporation (Phoenix, AZ) and Arizona Acute Medical Services 1 PC (Phoenix, AZ). Each 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 Jacob Russell's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jacob Russell was last updated on July 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.