JENNIFER ANN RUSSELL DDS
NPI 1508375130
Dentist - General Practice in Green Bay, WI

Q: What is Jennifer Russell's NPI number?

The NPI number for Jennifer Russell is 1508375130. It was assigned to this individual provider in the NPPES registry on September 27, 2017.

Q: What is Jennifer Russell's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: Is Jennifer Russell enrolled in Medicare?

No. Jennifer Russell has opted out of Medicare through November 26, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Jennifer Russell was last updated on February 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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 September 27, 2017Opted out of Medicare · through Nov 26, 2027

2851 UNIVERSITY AVE, GREEN BAY, WI 54311(920) 431-2500 Get Directions Write a Review

NPPES record last updated: February 26, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jennifer Ann Russell Dds NPPES

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

JENNIFER ANN RUSSELL DDS (NPI 1508375130) is an individual general practice provider in Green Bay, Wisconsin, licensed in Wisconsin (1001792) and active in the NPI registry since September 2017. She has opted out of Medicare through November 26, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1508375130

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameJENNIFER ANN RUSSELLCredential: DDS

Location Address2851 UNIVERSITY AVEGreen Bay, WI 54311

Mailing Address2851 University AveGreen Bay, WI 54311-5855

Phone(920) 431-2500

Sole ProprietorNo

Enumeration DateSeptember 27, 2017

Last NPPES UpdateFebruary 26, 2025

NPPES CertifiedFebruary 26, 2025

✔ NPI 1508375130 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in WI · 1001792

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2851 UNIVERSITY AVE, Green Bay, WI 54311

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jennifer Ann Russell Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 26, 2019 through November 26, 2027.

Opt-Out Effective DateNovember 26, 2019

Opt-Out In Effect ThroughNovember 26, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54311 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

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. KATHLEEN STOCKMAN MSW, LCSW, CSAC

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