| Russel James Nichols, MD | |
|
130 Thompson Avenue, Heppner, OR 97836 | |
| (541) 676-5504 | |
| (541) 676-8247 |
| Full Name | Russel James Nichols |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Experience | 28 Years |
| Location | 130 Thompson Avenue, Heppner, Oregon |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730187436 | NPI | - | NPPES |
| 287633 | Medicaid | OR | |
| 106707 | Other | OR | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD22062 (Oregon) | Secondary |
| 207Q00000X | Family Medicine | MD00039026 (Washington) | Secondary |
| 207P00000X | Emergency Medicine | MD22062 (Oregon) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Good Shepherd Home Health | Hermiston, OR | Home health agency |
| St Anthony Hospital | Pendleton, OR | Hospital |
| Pioneer Memorial Hospital (heppner) | Heppner, OR | Hospital |
| Good Shepherd Medical Center | Hermiston, OR | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| St Anthony Hospital | 3678568268 | 13 |
| Entity Name | Good Shepherd Health Care System |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295789667 PECOS PAC ID: 9133033764 Enrollment ID: O20031118000046 |
| Entity Name | St Anthony Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831169903 PECOS PAC ID: 3678568268 Enrollment ID: O20040414001635 |
| Entity Name | Cep America Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780647719 PECOS PAC ID: 6608056171 Enrollment ID: O20130123000079 |
| Mailing Address | Practice Location Address |
|---|---|
| Russel James Nichols, MD Po Box 9, 564 E Pioneer Dr, Heppner, OR 97836 Ph: (541) 676-5504 | Russel James Nichols, MD 130 Thompson Avenue, Heppner, OR 97836 Ph: (541) 676-5504 |