Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Douglas Blane Russell, PA

Individual provider Physician Assistant · NPI 1487617619

Douglas Blane Russell, PA is a Physician Assistant in Yanceyville, North Carolina. Qualified in 2001, 25 years ago. Practices with Vidant Medical Group LLC, a 974-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
25
Licensed in
NC
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

439 US Hwy 158 W
Yanceyville, NC 27379
Phone: (336) 694-1181
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 103359 (NC)

Record details

NPI number1487617619
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedApril 10, 2006
Last updated in NPPESOctober 5, 2022
Certification dateOctober 5, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Group practice Vidant Medical Group Llc — 974 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations9 on file with Medicare

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