NPIMap

Individual provider Active NPI

Marina K Russo, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Springfield, IL
National Provider Identifier
1174510978
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
036102799 Issued in IL
Practice address
1118 Legacy Pointe Dr
Springfield, IL 62711
Phone
(217) 787-8870
Fax
(217) 787-6158
NPI assigned
Oct 5, 2005
Last updated
Jan 4, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 036102799 IL Primary

Addresses

Primary practice location

1118 Legacy Pointe Dr
Springfield, IL 62711

Mailing address

1118 Legacy Pointe Dr
Springfield, IL 62711
Phone (217) 787-8870

Other identifiers 6

IdentifierTypeStateIssuer
CD7143OtherILRR MEDICARE GRP
036102799MedicaidIL
14D0949277OtherILCLIA CERT
020057300OtherILBLACK LUNG
6394POtherILCATERPILLAR
08421024OtherILBLUE CROSS BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mrusso107404@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040317000621 IL Practitioner - EndocrinologyPractitioner - Internal Medicine 9830089556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

2901 Old Jacksonville Rd
Suite B4
Springfield, IL 62704-7439
Phone (217) 698-9722

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Prairie, Inc CurrentSince Dec 1, 2014 Accepting new patients
HSHS Prairie, Inc CurrentSince Dec 1, 2014 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Physicians Group Associates S C Endocrinology, Diabetes & Metabolism Past Accepting new patients
HSHS Medical Group Inc Past Accepting new patients
HSHS Prairie, Inc PastSince Mar 24, 2025 Accepting new patients
Physicians Group Associates S C Endocrinology, Diabetes & Metabolism Past Accepting new patients
Physicians Group Associates S C Past Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

1118 W Legacy Pointe Dr
Springfield, IL 62711
Phone (217) 528-3233

2901 Old Jacksonville Rd
Springfield, IL 62704
Phone (217) 698-9722

2901 Old Jacksonville Rd
Ste B4
Springfield, IL 62704
Phone (217) 241-3586

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

400 N Caldwell St
#H
Staunton, IL 62088
Phone (618) 635-2200

Interoperability endpoints

  • Direct secure messaging: mrusso107404@ewd.direct.hshs.org

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1174510978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 LEGACY POINTE DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62711",
            "telephone_number": "217-787-8870",
            "fax_number": "217-787-6158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 LEGACY POINTE DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62711",
            "telephone_number": "217-787-8870",
            "fax_number": "217-787-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MARINA",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-05",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": "036102799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GRP",
            "identifier": "CD7143",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102799",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERT",
            "identifier": "14D0949277",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "020057300",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CATERPILLAR",
            "identifier": "6394P",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "08421024",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mrusso107404@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1118 Legacy Pointe Dr",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.