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

Jacob Robert Russell, DO

Individual provider Emergency Medical Services (Emergency Medicine) Physician · NPI 1417318361

Jacob Robert Russell, DO is an Emergency Medicine in Surprise, Arizona. Graduated from Michigan State University College of Osteopathic Medicine in 2016, 10 years ago. Practices with Emergency Group of Arizona Professional Corporation, a 98-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Arizona and Michigan.

Years since qualifying
10
Trained at
Michigan State University College of Osteopathic Medicine
Licensed in
AZ, MI
In the registry since
2016
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

16815 W Bell Rd
Surprise, AZ 85374-2101
Phone: (602) 833-6900
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 15855 19 Mile Rd, Clinton Township, MI 48038-3504 — (586) 263-2300
  • 620 Skyline Dr, Jackson, TN 38301 — (731) 541-5000
  • 294 Summar Dr, Jackson, TN 38301-3915 — (731) 265-8220

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 008645 (AZ)
Emergency Medical Services (Emergency Medicine) Physician Taxonomy 207PE0004X · Licence 3749 (MI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1417318361
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMarch 18, 2016
Last updated in NPPESJuly 8, 2022
Certification dateJuly 8, 2022
Mailing address294 Summar Dr, Jackson, TN 38301-3915

Medicare enrollment

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

Medicare specialtyEMERGENCY MEDICINE
Medical schoolMICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduated 2016 (10 years in practice)
Group practice Emergency Group Of Arizona Professional Corporation — 98 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount