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Deactivated NPI 1386669356 Deactivated / Inactive NPI Male Practitioner

Dr. Charles A Russell , MD

Specialist • Enumclaw, WA

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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, Dr. Charles Russell has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 12, 2006
NPI Deactivation Date September 16, 2019
Total Practice Duration ~13 Years of Practice (2006 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Charles Russell, MD was a registered Specialist practicing in Enumclaw, WA. Throughout an active medical career spanning 13 years, Dr. Russell provided care at the practice location at 2820 GRIFFIN AVE STE 210 until profile deactivation on 2019-09-16.

Historical Medicare Part B clinical services included established patient outpatient office visit, new patient outpatient office visit, injection into tendon or ligament. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

2820 Griffin Ave Ste 210

Enumclaw, WA 980222373

Telephone 3608257500
Fax 3608253370
Associated Practice Facility / Clinic
🏢 Northwest Hand Therapy Facility NPI 1699989210

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Enumclaw, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 31.0 Yrs
State Avg: 35.4 Yrs
Regional Practice Density
11 Specialists

Practicing in Enumclaw, WA (2751 Statewide)

Telehealth Adoption Rate
9.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
62.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2019)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more
49 35 $175.00 $49.36
99202 New patient office or other outpatient visit, typically 20 minutes
27 27 $175.00 $82.98

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License WA MD00022648

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Dr. David Bishop , MD

Orthopaedic Surgery

NPI 1194878702

Doctor of Medicine (M.D.)

Patricia Bursch , RNSA

Registered Nurse - Medical-Surgical

NPI 1669625083
Angela Miller , CNM

Advanced Practice Midwife

NPI 1679749279

Certified Nurse Midwife

Dr. David Cortese , MD

Orthopaedic Surgery

NPI 1710098660

Doctor of Medicine (M.D.)

Amanda Lugo , PA-C

Physician Assistant - Surgical

NPI 1780062034

Physician Assistant (Certified)

Hannah Bishop

Internal Medicine - Cardiovascular Disease

NPI 1790263366

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 16, 2019

Record deactivated on September 16, 2019

NPI Profile Active December 05, 2011

NPI status registered as active in NPPES database

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Updated Practice Location December 05, 2011

Registered at 2820 GRIFFIN AVE STE 210, ENUMCLAW, WA 980222373 (Tel: 3608257500)

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Updated Business Mailing Address December 05, 2011

Registered at 2820 GRIFFIN AVE, STE 210, ENUMCLAW, WA 980222373 (Tel: 3608257500)

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Provider Name / Credentials Updated December 05, 2011

Recorded as CHARLES RUSSELL, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 05, 2011

Specialist (License #MD00022648 in WA)

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Initial NPI Registration & Enumeration July 12, 2006

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

NPI Number: 1386669356
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 12, 2006
Last Update: December 05, 2011
Deactivation Date: September 16, 2019

Mailing Address

2820 Griffin Ave, Ste 210

Enumclaw, WA 980222373

Phone: 3608257500

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.