NPIMap

Individual provider Active NPI

Anna Russo

  • Physician Assistant
  • Waterbury, CT
National Provider Identifier
1184000978
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
56 Franklin St
Waterbury, CT 06706-1253
Phone
(203) 709-6000
NPI assigned
Aug 4, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA5541 MA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

56 Franklin St
Waterbury, CT 06706-1253

Mailing address

110 Lawnwood Ave
Longmeadow, MA 01106-3021

Other practice location 1

40 Wright Street
Palmer, MA 01069
Phone (413) 284-5308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151124002235 CT Practitioner - Physician Assistant 8921308974 Reassigns benefits to 4 organizations
I20171107000924 MA Practitioner - Physician Assistant 8921308974 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverbend Medical Group IncGroup PAC ID 5698064343, 227 clinicians

Practice addresses (Care Compare)

175 Carew St
Suite 200
Springfield, MA 01104-2391
Phone (413) 734-8254

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC CurrentSince Apr 7, 2025 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Mar 27, 2022 Accepting new patients
Riverbend Medical Group, Inc. CurrentSince Mar 1, 2026 Accepting new patients
Cep America LLC CurrentSince Apr 7, 2025 Accepting new patients
Riverbend Medical Group, Inc CurrentSince Mar 1, 2026 Accepting new patients
Mwa,PC Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

115 Spencer St
Winsted, CT 06098
Phone (860) 738-5810

575 Beech St
Holyoke, MA 01040
Phone (413) 534-2570

175 Carew St
Ste 200
Springfield, MA 01104
Phone (413) 734-8254

233 Carew St
#101
Springfield, MA 01104
Phone (413) 748-9212

299 Carew St
Ste 419
Springfield, MA 01104
Phone (413) 737-7951

271 Carew St
Springfield, MA 01104
Phone (413) 748-9000

Interoperability endpoints

  • Direct secure messaging: anna.russo@pmuc.eclinicaldirectplus.com
  • Direct secure messaging: arusso2387914@direct.trinity-health.org

Organizations & group practices 11

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.

Hospital & facility affiliations 2

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": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1184000978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LAWNWOOD AVE",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011063021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061253",
            "telephone_number": "203-709-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 Wright Street",
            "address_purpose": "LOCATION",
            "city": "Palmer",
            "state": "MA",
            "postal_code": "01069",
            "country_code": "US",
            "telephone_number": "413-284-5308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "ANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-04",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA5541",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.