Shelly Russo, APRN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

11021994 Issued in FL

Practice address

1215 Jacaranda Blvd
Venice, FL 34292-4520

Phone

(941) 451-8282

Fax

(877) 652-3059

NPI assigned

Sep 23, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aneley Hundae Port Charlotte Cardiology LLCGroup PAC ID 8921345109, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087
• Adventhealth Port Charlotte Hospital, Port Charlotte, FL, CCN 100077

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73081

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.

• Aneley Hundae Port Charlotte Cardiology LLC

  • Cardiovascular Disease Physician
  • Port Charlotte, FL
  • NPI 1417424482
  Medicare reassignment Care Compare group NPD

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

• Adventhealth Port Charlotte Inc

  dba Adventhealth Port Charlotte

  • General Acute Care Hospital
  • Port Charlotte, FL
  • NPI 1760299093
  Care Compare affiliation
• Sarasota County Public Hospital District

  dba Sarasota Memorial Hospital

  • General Acute Care Hospital
  • Sarasota, FL
  • NPI 1245294826
  Care Compare affiliation

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1104549187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924520",
            "telephone_number": "941-451-8282",
            "fax_number": "877-652-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924520",
            "telephone_number": "941-451-8282",
            "fax_number": "877-652-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "SHELLY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-23",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "11021994",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11021994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James R. Rubinsak, M.D.
• Jacquelynn Ann Rubsam, CNP
• Wendy Russell
• Francis Alberto Russo
• Oliva Russo, APRN
• Kimberly Ann Ruzek, MD
• Ryan S. Holbrook, DMD, P.a. (Florida Dental Implant Center)
• Heather L. Ryan, MA, ATC, LAT
• Jeffrey Ryan, D.O.
• Patricia Jo Ryan, PH.D.

• Gerontology Nurse Practitioner in Venice, FL
• Providers in Venice, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.
• 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.