KEITH ANIEL RUSSWORM JR. NP
NPI 1497263222
Nurse Practitioner in Pine Bluff, AR

Q: What is Keith Russworm's NPI number?

The NPI number for Keith Russworm is 1497263222. It was assigned to this individual provider in the NPPES registry on January 15, 2018.

Q: What is Keith Russworm's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Keith Russworm was last updated on January 25, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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 January 15, 2018PECOS EnrolledAccepts Medicare Assignment

1600 W 40TH AVE, PINE BLUFF, AR 71603(870) 541-7100 Get Directions Write a Review

NPPES record last updated: January 25, 2018. Verified against the NPPES registry weekly; last sync: September 20, 2026.

On this page

About Keith Aniel Russworm Jr. Np NPPES

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

KEITH ANIEL RUSSWORM JR. NP (NPI 1497263222) is an individual nurse practitioner in Pine Bluff, Arkansas, licensed in Arkansas (A005484) and active in the NPI registry since January 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1497263222

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameKEITH ANIEL RUSSWORM JR.Credential: NP

Location Address1600 W 40TH AVEPine Bluff, AR 71603-6301

Mailing Address200 Corporate BlvdLafayette, LA 70508-3870 · (800) 893-9698

Phone(870) 541-7100

Sole ProprietorNo

Medical School CMSOtherGraduated 2017

Enumeration DateJanuary 15, 2018

Last NPPES UpdateJanuary 25, 2018

✔ NPI 1497263222 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in AR · A005484

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1600 W 40TH AVE, Pine Bluff, AR 71603

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, Health Advantage, Octave.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Keith Aniel Russworm Jr. Np 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 ID5395005748

PECOS Enrollment IDI20180205001537

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.

Areas of Expertise CMS Part B claims 2

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.

152 services146 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.

146 services143 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 71603 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

$79.72 typical visit price

range $51.36 – $157.74

Typical copayment $19.93 (range $12.84 – $39.43)

Most-billed visit code 99203

Established Patient

$91.63 typical visit price

range $16.16 – $128.77

Typical copayment $22.90 (range $4.04 – $32.19)

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.

MRS. REBEKAH A CROWDER MS, RD, LD, CDE

Dietitian, Registered