Jonathan Russ, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G11925 Issued in CA

Practice address

127 N Avalon Dr
Los Altos, CA 94022-2318

Phone

(650) 961-1102

Fax

(650) 887-2277

NPI assigned

Jan 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 4, 2015 through Nov 4, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003960592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1725",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940231725",
            "telephone_number": "650-961-1102",
            "fax_number": "650-887-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 N AVALON DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940222318",
            "telephone_number": "650-961-1102",
            "fax_number": "650-887-2277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3237 Sacramento St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941152047",
            "country_code": "US",
            "telephone_number": "659-961-1102",
            "fax_number": "650-887-2277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSS",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G11925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marina J Rose, D.C.
• Deborah Amy Rovine, MD
• Nicole Roy, PT
• Anastasiia Rukavyshnykova, PT
• Ilanit Ruppin, IBCLC
• Jill Rytand
• Sara Mozayeny Saatchi, PSYD.
• Safeway Inc
• Keith M Sakata, MD
• Leonora Mary Salado

• Psychiatry Physician in Los Altos, CA
• Providers in Los Altos, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.