Active NPI
Matthew John Russo, M.S., CCC-A
- Audiologist
- Peabody, MA
National Provider Identifier
1013946417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 777
- Practice address
- 7 Essex Green Dr
Suite 2
Peabody, MA 01960-2961 - Phone
- (978) 532-6650
- NPI assigned
- Jun 30, 2006
- Last updated
- Jan 14, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 777 | MA | Primary |
Addresses
Primary practice location
7 Essex Green Dr
Suite 2
Peabody, MA 01960-2961
Mailing address
PO Box 406153
Atlanta, GA 30384-1876
Phone (978) 532-6650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5104378 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 777 | MA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Audiology Distribution, LLC | Current | Accepting new patients | |
| Hearusa Inc | Past | Accepting new patients | |
| Home Health Vna Inc | Past | Accepting new patients | |
| Hearusa Inc | Audiologist | Past | Accepting new patients |
Locations
135 Massachusetts Ave
Arlington, MA 02474
Phone (781) 646-2040
7 Essex Green Dr
Ste 2
Peabody, MA 01960
Phone (978) 532-6650
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Audiologist-Hearing Aid Fitter
- West Palm Beach, FL
- NPI 1073560231
-
- Home Health Agency
- Bedford, NH
- NPI 1619433984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231891200000",
"number": "1013946417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 406153",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303841876",
"telephone_number": "978-532-6650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 ESSEX GREEN DR",
"address_2": "SUITE 2",
"city": "PEABODY",
"state": "MA",
"postal_code": "019602961",
"telephone_number": "978-532-6650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "MATTHEW",
"middle_name": "JOHN",
"credential": "M.S., CCC-A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2009-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MA",
"license": "777",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5104378",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peabody, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.