DR. THOMAS GERALD JR. RUSSELL (M.D.) – Emergency Medicine Physician, NPI 1417080631

DR. THOMAS GERALD JR. RUSSELL (M.D.) is a healthcare provider. based in Mayfield, Kentucky. specializing in EMERGENCY MEDICINE. They hold the professional credentials M.D.. They hold a License No. 27843 (KY). The NPI Number for DR. THOMAS GERALD JR. RUSSELL (M.D.) is 1417080631

Main info

Male
Sole Proprietor
41 Years Of Experience
Accepts Medicare Assignment
Name
DR. THOMAS GERALD JR. RUSSELL (M.D.)
NPI
1417080631
Phone
(270) 251-4242
Address
1099 MEDICAL CENTER CIR
Enumeration Date
14 March 2007
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Secondary Phone
9549395000
Graduation Year
1985 (41 years ago)
PAC ID
8022009141
Group Practice PAC ID
5799034799
Professional Enrollment ID
I20041209001087
Address ID
KY420033813PA2501XAVEX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

886 EMERGENCY MEDICINE in KY

Provider Addresses for DR. THOMAS GERALD JR. RUSSELL (M.D.)

  • 1099 MEDICAL CENTER CIR

    MAYFIELD, KY 420661159

    Phone: (270) 251-4242

    Fax: (270) 251-4240

    Type: Location

  • 934 STATE ROUTE 2205

    MAYFIELD, KY 420664886

    Phone: (270) 247-9601

    Fax: (270) 247-9601

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $111.

Total Amount is formed as General ($111) + Research ($0) + Ownership ($0) = $111.

Last reported payment date: 2024-09-24 • Largest payer in this snapshot: Y-mAbs Therapeutics, Inc. ($111).

Total Amount

$111

General + Research + Ownership

Payments

2

Total payment records

General Amount

$111

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-24

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Y-mAbs Therapeutics, Inc.$111
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-12-09

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20041209001087IEmergency MedicineKYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making112107$0
99284Emergency department visit with moderate level of medical decision making9796$0
99283Emergency department visit with low level of medical decision making1312$0
View full utilization report →

Insurance plans in this area (ZIP 42066)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5799034799View full group profile
NameSpecialtyState
Emergency MedicineMI
Emergency MedicineOH
Emergency MedicineGA
-KY
Internal Medicine, Emergency MedicineKY
Emergency MedicineCA
Emergency MedicineKY
Emergency MedicineCO
Emergency MedicineNJ
Emergency MedicineKY

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Frequently asked questions

How do I look up DR. THOMAS GERALD JR. RUSSELL (M.D.) by NPI?
Use NPI 1417080631 when you need to reference DR. THOMAS GERALD JR. RUSSELL (M.D.) in forms, claims, or directories.
Is DR. THOMAS GERALD JR. RUSSELL (M.D.) active in the national directory?
DR. THOMAS GERALD JR. RUSSELL (M.D.)'s public NPI profile is in an active state.
What kind of provider is DR. THOMAS GERALD JR. RUSSELL (M.D.)?
The page reflects Emergency Medicine Physician for DR. THOMAS GERALD JR. RUSSELL (M.D.). Clinical services aligned with this taxonomy classification.
What location metadata exists for DR. THOMAS GERALD JR. RUSSELL (M.D.)?
The page summarizes Mayfield, Kentucky for DR. THOMAS GERALD JR. RUSSELL (M.D.); expand the address list for detail.
Is DR. THOMAS GERALD JR. RUSSELL (M.D.) a real provider?
This page reflects official NPPES data for NPI 1417080631. Always confirm identity and privileges with the practice and licensing boards.

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