MARY EILEEN KUMAH RUSSELL ACNP
NPI 1417518747
Nurse Practitioner - Gerontology in Philadelphia, PA
About Mary Eileen Kumah Russell Acnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARY EILEEN KUMAH RUSSELL ACNP (NPI 1417518747) is an individual gerontology provider in Philadelphia, Pennsylvania, licensed in Arizona (228209) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mary Eileen Kumah Russell Acnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mary Russell reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Brentwood, TN 37027
- Reassigned Medicare billing, Arizona enrollment
- 67 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 19103 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
PHILADELPHIA, PA 19103
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 Mary Russell's NPI number?
The NPI number for Mary Russell is 1417518747. It was assigned to this individual provider in the NPPES registry on June 26, 2019.
Where is Mary Russell located?
Mary Russell practices at 1650 Market St Ste 3600, Philadelphia, PA 19103. The listed phone number is (855) 212-2273.
What is Mary Russell's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Mary Russell enrolled in Medicare?
Yes. Mary Russell is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Mary Russell's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Russell reassigns Medicare benefits to Monogram Health Professional Services PC (Brentwood, TN). The 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 Mary 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 Mary Russell was last updated on October 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 days 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.
# Mary Eileen Kumah Russell, ACNP · NPI 1417518747
Gerontology physician in Philadelphia, Pennsylvania. Individual provider, active in the CMS NPPES registry since June 26, 2019.
## Identity
- **NPI:** 1417518747 (Entity type: Individual)
- **Enumerated:** June 26, 2019
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **State license:** 228209 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1650 MARKET ST STE 3600, Philadelphia, PA 19103-7334
- **Phone:** (855) 212-2273 · **Fax:** (629) 240-6003
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Monogram Health Professional Services PC (NPI 1952917122, Brentwood, TN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 19, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1417518747) · Data from the CMS NPPES public registry.