Individual provider Active NPI

Benjamin Russo, D.O.

  • Anesthesiology Physician
  • New York, NY
National Provider Identifier
1053758425
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
292674 Issued in NY
Practice address
506 Lenox Ave
New York, NY 10037-1802
Phone
(212) 939-3550
NPI assigned
May 25, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 292674 NY Primary

Addresses

Primary practice location

506 Lenox Ave
New York, NY 10037-1802

Mailing address

NYU Langone Medical Center
550 1St Ave
New York, NY 10010-6402
Phone (917) 703-9177

Other practice location 1

5 Cliff Rd
Port Jefferson, NY 11777-1261
Phone (917) 703-9177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180815003439 NY Practitioner - Anesthesiology 9537418199 Reassigns benefits to 2 organizations
I20240531001701 NJ Practitioner - Anesthesiology 9537418199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Jersey Healthcare Specialists PCGroup PAC ID 2668385253, 570 clinicians

Practice addresses (Care Compare)

30 Prospect Ave
Hackensack, NJ 07601-1914
Phone (201) 488-0066

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Harlem Medical Associates PC CurrentSince Jul 23, 2018 Accepting new patients
New Jersey Healthcare Specialists PC Anesthesiology CurrentSince Jun 1, 2024 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Mar 1, 2024 Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

45 Research Way
Ste 206
Setauket, NY 11733
Phone (631) 575-9300

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: brusso682065@nychhc.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1369440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1053758425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NYU LANGONE MEDICAL CENTER",
            "address_2": "550 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100106402",
            "telephone_number": "917-703-9177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-939-3550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Cliff Rd",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson",
            "state": "NY",
            "postal_code": "117771261",
            "country_code": "US",
            "telephone_number": "917-703-9177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "BENJAMIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-25",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "292674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.