Bryan Clint Russell, is a medicare enrolled "Physical Medicine & Rehabilitation" physician in Coronado, California. His current practice location is
160 C Ave, Coronado, California. You can reach out to his office (for appointments etc.) via phone at
(619) 319-5992.
Bryan Clint Russell is licensed to practice in California (license number PT295117) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1407320260.
Physician's Profile
| Full Name | Bryan Clint Russell |
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| Gender | Male |
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| Speciality | Physical Medicine & Rehabilitation |
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| Location | 160 C Ave, Coronado, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1407320260
- Provider Enumeration Date: 01/15/2019
- Last Update Date: 01/15/2019
Medicare PECOS Information:
- PECOS PAC ID: 2668902859
- Enrollment ID: I20250203002414
Medical Identifiers
Medical identifiers for Bryan Clint Russell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1407320260 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208100000X | Physical Medicine & Rehabilitation | PT295117 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Bryan Clint Russell allows following entities to bill medicare on his behalf.
| Entity Name | One Life Physical Therapy Inc |
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| Entity Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
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| Entity Identifiers | NPI Number: 1144851361
PECOS PAC ID: 1759811946
Enrollment ID: O20250203002331 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Bryan Clint Russell is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Bryan Clint Russell,
6621 Archwood Ave,
San Diego, CA 92120-2401
Ph: (619) 319-5992 | Bryan Clint Russell,
160 C Ave,
Coronado, CA 92118-1420
Ph: (619) 319-5992 |
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