Dr. Kermit Russell Rust IIi
Radiology (Vascular & Interventional Radiology)

Address: 900 23rd St Nw, Suite G-2092, Room 122, Washington, DC 20037-2342
Phone: 4193675198

Dr. Kermit Russell Rust IIi (NPI# 1194036574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1194036574
Entity Type Individual
Full Name Dr. Kermit Russell Rust IIi
Credential M.D.
Gender Male
Practice Address 900 23rd St Nw
Suite G-2092, Room 122
Washington
DC 20037-2342
Practice Telephone 4193675198
Mailing Address 13800 Oxford Dr
Edmond
Edmond
OK 73013-9782
Mailing Telephone 4193675198
Sole Proprietor Yes, this individual is a Sole Proprietor
Enumeration Date 2010-06-30
Last Update Date 2015-04-10

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
No 207R00000X Internal Medicine Allopathic & Osteopathic Physicians 125058810 IL
No 2085R0202X Radiology · Diagnostic Radiology Allopathic & Osteopathic Physicians 28347 OK
Yes 2085R0204X Radiology · Vascular & Interventional Radiology Allopathic & Osteopathic Physicians MD043000 DC

Physician Overview

NPI 1194036574
PAC ID by PECOS 6709879554
Professional Enrollment ID I20160607000262
Full Name Kermit R Rust
Organization Legal Name WICHITA RADIOLOGICAL GROUP PROF ASSOC
Phone Number 3166851367
Gender M
Credential PA
Graduation Year 2010
Primary Specialty INTERVENTIONAL RADIOLOGY
Secondary Specialties VASCULAR SURGERY
Group Practice PAC ID 6507762960
Number of Group Practice Members 28
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
170123 WESLEY MEDICAL CENTER
170150 SOUTH CENTRAL KS MED CENTER
171339 GREENWOOD COUNTY HOSPITAL

Office Location

Street Address 900 23RD ST NW
SUITE G-2092, ROOM 122
City WASHINGTON
State DC
Zip Code 20037-2342

Providers in the same location

NPI Name Taxonomy Address Enumeration
1659376366 Patricia G Roberts Internal Medicine 900 23rd St Nw, Washington, DC 20037-2342 2005-06-17
1093289332 Sarah Yi Physician Assistant 900 23rd St Nw, Washington, DC 20037-2342 2019-01-21
1013481753 Callie Beegle Physician Assistant 900 23rd St Nw, Washington, DC 20037-2342 2019-01-16
1114492048 Kendarius S Talton Nurse Practitioner 900 23rd St Nw, Washington, DC 20037-2342 2018-10-08
1386128437 Sung Min Kim Registered Nurse 900 23rd St Nw, Washington, DC 20037-2342 2018-09-24
1134603277 Anne Laurel Kure Physician Assistant 900 23rd St Nw, Washington, DC 20037-2342 2018-09-24
1336623099 Ashley Elizabeth Young Nurse Practitioner 900 23rd St Nw, Washington, DC 20037-2342 2018-09-19
1083197669 Weng Kay Christina Chen Student in an Organized Health Care Education/Training Program 900 23rd St Nw, Washington, DC 20037-2342 2018-09-10
1477031417 Dolores C Villar Physician Assistant 900 23rd St Nw, Washington, DC 20037 2018-08-01
1689152795 Laura Anne Bradley Physician Assistant 900 23rd St Nw, Washington, DC 20037-2342 2018-07-31
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1992280044 Aakshit Goyal Student in an Organized Health Care Education/Training Program The George Washington University Hospital, 900, 23 Rd Street, Washington, DC 20037 2018-09-25
1649752015 Jamie Peterson Counselor 3 Washington Circle Nw, Suite 406, Washington, DC 20037 2018-09-03
1003392689 Eugenie Atallah Student in an Organized Health Care Education/Training Program The Gw Medical Faculty Associates 2150 Pennsylvania Ave, 2150 Pennsylvania Avenue, Nw, Washington, DC 20037 2018-07-17
1033637541 Brianna Bachelle Eliades Physical Medicine & Rehabilitation 2175 K Street, Nw, C120, Washington, DC 20037 2017-09-05
1376067967 Candace Mary Willett Pediatrics 2440 M St Nw Ste 205, Washington, DC 20037 2017-07-26
1982125894 Fransisca Indraswari Student in an Organized Health Care Education/Training Program The George Washington Medical Faculty Associates, 2150 Pennsylvania Avenue Nw, Washington, DC 20037 2017-06-30
1750816021 Mohammed Alsaggaf Student in an Organized Health Care Education/Training Program 900 23rd St Nw, Washington, Dc 20037, Usa, Washington, DC 20037 2017-04-25
1194275560 Kathryn Estopinal Registered Nurse 2300 M Street, Nw, 5th Floor, Washington, DC 20037 2016-10-10
1346693330 Alexandra Brennan Moskowitz Nurse Practitioner Gwu Hospital, 900 23rd Street Nw, Washington, DC 20037 2016-07-14
1205283488 Addison Stafford Gearhart Student in an Organized Health Care Education/Training Program 1010 25th St Nw Apt 109, Washington, DC 20037 2016-05-18
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Taxonomy Information

Taxonomy Code 2085R0204X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Vascular & Interventional Radiology

Taxonomy Definition

A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1932307295 Venkatesh Perumal Krishnasamy Radiology 900 23rd St Nw # G2092, The Gw Medical Faculty Associates, Washington, DC 20037-2342 2007-07-10
1386975795 District Vascular Institute LLC Radiology 1010 Vermont Ave Nw, Suite 300, Washington, DC 20005-4902 2010-01-25
1174779946 Donna Carol Buckley Radiology 3800 Reservoir Rd Nw, Washington, DC 20007-2113 2008-08-13
1215183991 Alexander Y Kim Radiology 3800 Reservoir Rd Nw, Washington, DC 20007-2113 2008-08-13
1093977415 Frank J Groshek Radiology 1150 Varnum St Ne, Department of Radiology, Washington, DC 20017-2104 2008-06-26
1972700334 Theresa Michelle Caridi Radiology 3800 Reservoir Rd Nw, Cg201, Washington, DC 20007-2113 2007-06-29
1851462675 Anthony Charles Venbrux Radiology 900 23rd St Nw, Washington, DC 20037-2342 2006-11-13
1487742029 Shawn Nath Sarin Radiology 900 23rd St Nw, Washington, DC 20037-2342 2006-10-10
1811093727 Houtan Adib Radiology Vamc 50 Irving St Nw, Washington, DC 20422-0001 2006-09-16
1952311607 Joseph Martin Giordano Radiology 2150 Pennsylvania Ave Nw, Washington, DC 20037-3201 2006-08-08
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Competitor

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City WASHINGTON
Zip Code 20037

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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