Anthony Leonard Russo, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

M-8310 Issued in ID

Practice address

750 N Syringa St Ste 100
Post Falls, ID 83854-5275

Phone

(208) 262-2600

Fax

(208) 262-2700

NPI assigned

Aug 23, 2005

Last updated

Nov 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

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  dba Lima Memorial Health System

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  • Lima, OH
  • NPI 1336144732
  NPD (past)
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  dba Village Medicine

  • Medical Specialty Clinic/Center
  • Seattle, WA
  • NPI 1922359546
  NPD (past)

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1144213455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1593 E POLSTON AVE",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838545326",
            "telephone_number": "208-262-2300",
            "fax_number": "208-262-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N SYRINGA ST STE 100",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838545275",
            "telephone_number": "208-262-2600",
            "fax_number": "208-262-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 W Dalton Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838158600",
            "country_code": "US",
            "telephone_number": "208-209-2060",
            "fax_number": "208-209-2070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "ANTHONY",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-8310",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD61084253",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144213455",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2106800",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medicine Physician in Post Falls, ID
• Providers in Post Falls, ID by specialty
• Emergency Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.