Jacquelyn Kay Russell , PA
Physician Assistant • Iliamna, AK
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Jacquelyn Russell has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Jacquelyn Russell, PA was a registered Physician Assistant practicing in Iliamna, AK. Throughout an active medical career spanning 27 years, Jacquelyn Russell provided care at the practice location at 101 AIRPORT WAY until profile deactivation on 2024-08-16.
Jacquelyn Russell was affiliated with Southcentral Foundation and accepted Medicare assignment.
Historical Medicare Part B clinical services included established patient outpatient office visit, emergency department visit with straightforward medical decision making, emergency department visit with low level of medical decision making. Public procedure reimbursement records and service volume details are provided below for historical transparency.
Practice Location & Contact Primary Location
101 Airport Way
Iliamna, AK 99606
Medicare Profile & Education
Other
1997
✓ Accepts Assignment
In-Person Only
Specialty Benchmarks & Practice Insights
Comparative analytics for Physician Assistant in Iliamna, AK
Practicing in Iliamna, AK (551 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Clinical Seniority & Experience Comparison
Performed Procedures & Service Volume
Top Medicare Part B procedures performed by this practitioner
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
26 | 14 | $164.22 | $95.98 |
Medical Specialties & State Licenses
CMS Verified: 2024-08-30NUCC Taxonomy Code: 363A00000X
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
NUCC Taxonomy Code: 363A00000X
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
NUCC Taxonomy Code: 363A00000X
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Additional State Medicaid & Healthcare Payer Identifiers
Hospital & Practice Group Affiliations
Southcentral Foundation
101 Airport Rd, Iliamna, AK 99606
Phone: 9075711818
Southcentral Foundation
1008 Main St, Kockhanok, AK 99606
Phone: 9072822203
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Counselor - Professional
Licensed Professional Counselor, Master of Science, Licensed Mental Health Counselor, CAP
Physician Assistant
Physician Assistant (Certified)
Counselor
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Registered at 101 AIRPORT WAY, ILIAMNA, AK 99606 (Tel: 9075711818)
Registered at 31 EMBRETSON ROAD, ILIAMNA, AK 99606 (Tel: 9077448581)
Recorded as JACQUELYN RUSSELL, PA
Record officially reactivated for active practice on August 30, 2024
Record deactivated on August 16, 2024
Registered at 1255 PICKNEY RD, COPENHAGEN, NY 136263342 (Tel: 9074069315)
Physician Assistant (License #085.004670 in IL)
Registered at 457 GAFFNEY DR, WATERTOWN, NY 136011834 (Tel: 9074069315)
Registered at 1255 PICKNEY RD, COPENHAGEN, NY 136263342 (Tel: 9074069315)
Registered at 7785 N STATE ST STE 230, LOWVILLE, NY 133671229 (Tel: 9077471722)
Registered at PO BOX 2337, SYRACUSE, NY 132202337 (Tel: 3157015676)
Physician Assistant (License #023071 in NY)
NPI status registered as active in NPPES database
Registered at 517 N MAIN ST, ANNA, IL 629061668 (Tel: 6188332295)
Registered at 517 N MAIN ST, ANNA, IL 629061668 (Tel: 6188332295)
Recorded as JACQUELYN BARNES, PA
Physician Assistant (License #085.004670 in IL)
First registered as active Individual Practitioner in NPPES Database.
Patient & Community Reviews
Verified patient ratings, medical care experiences, and facility photos
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NPI Administrative Meta
Mailing Address
31 Embretson Road
Iliamna, AK 99606
Phone: 9077448581
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