KELLY ANN RUSSELL MD
NPI 1780430702
Student in an Organized Health Care Education/Training Program in Detroit, MI

Q: What is Kelly Russell's NPI number?

The NPI number for Kelly Russell is 1780430702. It was assigned to this individual provider in the NPPES registry on April 29, 2024.

Q: What is Kelly Russell's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Russell was last updated on May 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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 April 29, 2024PECOS Enrolled

2799 W GRAND BLVD, DETROIT, MI 48202(313) 916-2600 Get Directions Write a Review

NPPES record last updated: May 17, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 17, 2024, Apr 29, 2024 (2 updates tracked since 2024).

On this page

About Kelly Ann Russell Md NPPES

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

KELLY ANN RUSSELL MD (NPI 1780430702) is an individual student in an organized health care education/training program in Detroit, Michigan, licensed in Michigan (4351053278) and active in the NPI registry since April 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1780430702

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameKELLY ANN RUSSELLCredential: MD

Location Address2799 W GRAND BLVDDetroit, MI 48202-2608

Mailing Address2799 W Grand BlvdDetroit, MI 48202-2608 · (313) 916-2600

Phone(313) 916-2600

Sole ProprietorNo

Enumeration DateApril 29, 2024

Last NPPES UpdateMay 17, 20242 updates tracked since enumeration

NPPES CertifiedMay 17, 2024

✔ NPI 1780430702 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 4351053278

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

2799 W GRAND BLVD, Detroit, MI 48202

Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Ann Russell Md 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.

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.

HENRY FORD HOSPITAL

General Acute Care Hospital