Sam Dominick Russo, MPAS

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

650 W 168TH St
New York, NY 10032-3702

Phone

(212) 305-7367

NPI assigned

Sep 15, 2014

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

Medicare fee-for-service enrollment

Enrolled in NY

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

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northern Westchester Hospital Hospital, Mount Kisco, NY, CCN 330162

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: srusso69462@northwell.direct-ci.com

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• Ashraf Medical Group PLLC

  • Urgent Care Clinic/Center
  • Wappingers Falls, NY
  • NPI 1821387382
  Medicare reassignment
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• Clinic 21 of Connecticut LLC

  • Emergency Medicine Physician
  • Stamford, CT
  • NPI 1760856306
  NPD (past)

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

• Northern Westchester Hospital Association

  • Medicare Defined Swing Bed Hospital Unit
  • Mount Kisco, NY
  • NPI 1396178356
  Care Compare affiliation
• Northern Westchester Hospital Association

  • General Acute Care Hospital
  • Mount Kisco, NY
  • NPI 1912992215
  Care Compare affiliation

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410739200000",
    "number": "1164823787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3632 WILDWOOD ST",
            "city": "YORKTOWN HEIGHTS",
            "state": "NY",
            "postal_code": "105981129",
            "telephone_number": "914-582-8342",
            "fax_number": "914-245-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323702",
            "telephone_number": "212-305-7367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "SAM",
        "middle_name": "DOMINICK",
        "name_prefix": "Mr.",
        "credential": "MPAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-15",
        "last_updated": "2014-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Anthony Russo, MD
• Nicole Russo, CASAC-T
• Nora Russo, FNP
• Olivia Pagliaro Russo
• Paul Russo, MD
• Tara Russo, NP
• Taylor Marie Russo I, MSPAS, PA-C
• Margarita Russolello, DACM, L.AC.
• Maria Russolello
• Russom Psychiatry, PLLC

• Medical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; 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.