Gordon J Russo, MD

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

015208 Issued in LA

Practice address

120 Meadowcrest St
Suite 160
Gretna, LA 70056-5255

Phone

(504) 391-7620

Fax

(504) 391-7524

NPI assigned

Jul 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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 1

Specialty

Dermatology

Education

Louisiana State University School of Medicine in New Orleans, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Westside Dermatology Associates a Professional Medical CorporationGroup PAC ID 0446270854, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Westside Dermatology Associates a Professional Medical Corporation

  • Specialist
  • Gretna, LA
  • NPI 1588725808
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1083612469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3725 LAKE MICHAEL CT",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700568326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEADOWCREST ST",
            "address_2": "SUITE 160",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700565255",
            "telephone_number": "504-391-7620",
            "fax_number": "504-391-7524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "GORDON",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "LA",
            "license": "015208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1329495",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Roubion
• Chad M Rudolph, PHARM D.
• Natha Lee Ruffin
• Russell Schafer Dental Clinic LLC
• Glenn Gerard Russo, M.D.
• Peter Russo
• S & C Total Living Inc.
• S & C Total Living Inc.
• S & C Total Living Inc.
• S & C Total Living Inc.

• Procedural Dermatology Physician in Gretna, LA
• Providers in Gretna, LA by specialty
• Procedural Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.