EDDIE RUSSELL (CRNA) – Certified Registered Nurse Anesthetist, NPI 1154563336

EDDIE RUSSELL (CRNA) is a healthcare provider. based in Philadelphia, Pennsylvania. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. 26NR08427000 (NJ). The NPI Number for EDDIE RUSSELL (CRNA) is 1154563336

Main info

Male
18 Years Of Experience
Accepts Medicare Assignment
Name
EDDIE RUSSELL (CRNA)
NPI
1154563336
Phone
(215) 955-6161
Address
111 S 11TH ST
Enumeration Date
2 April 2009
Last Update Date
30 September 2015

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8564324116
Graduation Year
2008 (18 years ago)
PAC ID
4880743871
Group Practice PAC ID
4082920525
Professional Enrollment ID
I20090521000526
Address ID
NJ080434910VO93XXXRDXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience62
Completeness75
Years active:17State licenses:2Digital endpointsOther names

4,245 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in PA

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Provider Addresses for EDDIE RUSSELL (CRNA)

  • Thomas Jefferson University Hospital, 111, South 11th Street, Philadelphia, Philadelphia County, Pennsylvania, 19107, United States

    STE 8490

    PHILADELPHIA, PA 191074824

    Phone: (215) 955-6161

    Fax: (215) 923-5507

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2015-09-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

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
I20090521000526ICertified Registered Nurse Anesthetist (Crna)NJTBD
I20150923001313ICertified Registered Nurse Anesthetist (Crna)PATBD

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 19107)

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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: 4082920525View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)NJ
Certified Registered Nurse Anesthetist (Crna)PA
Certified Registered Nurse Anesthetist (Crna)PA
Certified Registered Nurse Anesthetist (Crna)NJ
Certified Registered Nurse Anesthetist (Crna)TX
Certified Registered Nurse Anesthetist (Crna)MD
Certified Registered Nurse Anesthetist (Crna)NJ
A N E S T H E S I O L O G YPA
A N E S T H E S I O L O G YNJ
Certified Registered Nurse Anesthetist (Crna)PA

Reviews

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Frequently asked questions

How is EDDIE RUSSELL (CRNA) identified in CMS data?
CMS-hosted NPPES data lists EDDIE RUSSELL (CRNA) with NPI 1154563336.
Does CMS list EDDIE RUSSELL (CRNA) as active?
Yes — EDDIE RUSSELL (CRNA) is active in the NPI listing used on this page.
What is EDDIE RUSSELL (CRNA)'s primary classification?
Certified Registered Nurse Anesthetist is the headline specialty for EDDIE RUSSELL (CRNA) here. Clinical services aligned with this taxonomy classification.
Where is EDDIE RUSSELL (CRNA) based?
EDDIE RUSSELL (CRNA) is tied to Philadelphia, Pennsylvania in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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