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Samuel Peter Russell

Pediatrics

Allopathic & Osteopathic Physicians

3020 Childrens Way, San Diego, CA 92123-4223

PECOS Enrollment

This provider is enrolled in PECOS as SAMUEL RUSSELL.

Based on the most recent information from CMS, provider Samuel Peter Russell is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 2:29 PM.

Profile Details

Provider ID
1215564265
Provider Type
Individual
Full Name
Russell, Samuel Peter
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/26/2020
Last Updated
5/10/2023

Contact Information

Practice Location

3020 Childrens Way, San Diego, CA 92123-4223

(858) 966-8800

Unlisted Fax

Mailing Location

3020 Childrens Way # Mc5003, San Diego, CA 92123-4223

(858) 309-6300

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208000000X Primary	Description Pediatrics Allopathic & Osteopathic Physicians	License A186031 California

Samuel Peter Russell

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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