MARY EILEEN KUMAH RUSSELL ACNP
NPI 1417518747
Nurse Practitioner - Gerontology in Phoenix, AZ

Q: 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.

Q: What is Mary Russell's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Q: When was this NPI record last updated?

The NPPES record for Mary Russell was last updated on March 31, 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.

Active since June 26, 2019PECOS Enrolled

625 N 6TH ST, PHOENIX, AZ 85004(602) 406-8222(602) 406-7811 Get Directions Write a Review

NPPES record last updated: March 31, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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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 Phoenix, Arizona, licensed in Arizona (228209) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS and maintains a secondary practice location in Glendale.

NPPES Registry Identity

NPI1417518747

Entity TypeIndividualFemale

Primary Taxonomy363LG0600X

Provider Legal NameMARY EILEEN KUMAH RUSSELLCredential: ACNP

Location Address625 N 6TH STPhoenix, AZ 85004-2155

Mailing AddressPo Box 33269Phoenix, AZ 85067-3269 · (602) 406-4786 · Fax (916) 636-4358

Phone(602) 406-8222

Fax(602) 406-7811

Sole ProprietorYes

Enumeration DateJune 26, 2019

Last NPPES UpdateMarch 31, 2022

NPPES CertifiedMarch 31, 2022

✔ NPI 1417518747 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LG0600X

License✔ Licensed in AZ · 228209

625 N 6TH ST, Phoenix, AZ 85004

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Secondary Practice Location 1

Location 17330 N 99th Ave Ste 300350Glendale, AZ 85307-3015 · Phone (602) 406-0220 · Fax (602) 406-0242

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary Eileen Kumah Russell Acnp 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85004 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 20

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

DR. JASON T. WISEMAN MD, MSPH

Surgery (Surgical Oncology)