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

Justin Lee Russell, PA

Individual provider Surgical Physician Assistant · NPI 1710539416

Justin Lee Russell, PA is a Physician Assistant in Bradenton, Florida. Qualified in 2019, 7 years ago. Practices with Kennedy White and Riggs Orthopedic Associates, a 37-clinician group and accepts Medicare assignment.

Years since qualifying
7
In the registry since
2019
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

11505 Rangeland Pkwy
Bradenton, FL 34211-4041
Phone: (941) 362-8662
Fax: (941) 362-8602
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X

Record details

NPI number1710539416
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJuly 12, 2019
Last updated in NPPESMay 7, 2020
Certification dateMay 7, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Kennedy White And Riggs Orthopedic Associates — 37 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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