NPIMap

Organization Active NPI

Orthopaedic Specialty Group, P.C.

Doing business as Robert D. Russo, M.D. & Associates Radiology, P.C.

  • Diagnostic Radiology Physician
  • Fairfield, CT
National Provider Identifier
1114923893
Registry record updated Dec 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
016805 Issued in CT
Legal business name
ORTHOPAEDIC SPECIALTY GROUP, P.C.
Doing business as
Robert D. Russo, M.D. & Associates Radiology, P.C.
Practice address
305 Black Rock Tpke
Fairfield, CT 06825
Phone
(203) 337-2600
NPI assigned
Jun 27, 2005
Last updated
Dec 14, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2018

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

Authorized official

Name
Judith Ortiz
Title
Credentialing Coordinator
Phone
(203) 538-5233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 016805 CT Primary

Addresses

Primary practice location

305 Black Rock Tpke
Fairfield, CT 06825

Mailing address

PO Box 6128
Bridgeport, CT 06606-0128
Phone (203) 538-5233

Other practice location 1

305 Black Rock Tpke
Fairfield, CT 06825
Phone (203) 337-2600 ext. 1126

Other names 1

  • Robert D. Russo, M.D. & Associates Radiology, P.C. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050428000802 CT Part B Supplier - Clinic/Group Practice 8820037898 Receives reassigned benefits from 97 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monroe, CT; Shelton, CT; Fairfield, CT; Milford, CT; Bridgeport, CT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

305 Black Rock Tpke
Fairfield, CT 06825
Phone (203) 337-2600

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544745600000",
    "number": "1114923893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6128",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066060128",
            "telephone_number": "203-538-5233",
            "fax_number": "203-538-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 BLACK ROCK TPKE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06825",
            "telephone_number": "203-337-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 Black Rock Tpke",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CT",
            "postal_code": "06825",
            "country_code": "US",
            "telephone_number": "203-337-2600 x1126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORTHOPAEDIC SPECIALTY GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2018-12-14",
        "status": "A",
        "authorized_official_last_name": "ORTIZ",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "203-538-5233"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CT",
            "license": "016805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robert D. Russo, M.D. & Associates Radiology, P.C.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Robert D. Russo, M.D. & Associates Radiology, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; 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.

Verify at the official NPI Registry.