Individual provider Active NPI

Sherie Russo, PT

  • Physical Therapist
  • Syosset, NY
National Provider Identifier
1093734998
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
012153-1 Issued in NY
Practice address
567 Jericho Tpke
Suite 202
Syosset, NY 11791-4505
Phone
(516) 364-6720
NPI assigned
Jul 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 012153-1 NY Primary

Addresses

Primary practice location

567 Jericho Tpke
Suite 202
Syosset, NY 11791-4505

Mailing address

567 Jericho Tpke
Suite 202
Syosset, NY 11791-4505
Phone (516) 364-6720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211013001937 NY Practitioner - Physical Therapist in Private Practice 6709284243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

340 Dogwood Ave
Franklin Square, NY 11010-3409
Phone (516) 437-5300

4250 Hempstead Tpke
Bethpage, NY 11714-5711
Phone (516) 579-7870

70 Maple Ave
Rockville Centre, NY 11570-4225
Phone (516) 536-7388

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012153-1NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Aug 3, 2021 Accepting new patients
Montefiore Medical Center CurrentSince Aug 3, 2021 Accepting new patients
Farmingdale Physical Therapy Assoc PC Past Accepting new patients
All-Star Physical Therapy,PC Physical Therapist PastSince Dec 26, 2018 Accepting new patients
Farmingdale Physical Therapy East LLC Physical Therapist PastSince Aug 1, 2015 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

340 Dogwood Ave
Ste 105
Franklin Square, NY 11010
Phone (516) 437-5300

Networks

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

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1093734998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 JERICHO TPKE",
            "address_2": "SUITE 202",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117914505",
            "telephone_number": "516-364-6720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 JERICHO TPKE",
            "address_2": "SUITE 202",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117914505",
            "telephone_number": "516-364-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "SHERIE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "012153-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syosset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.