NPIMap

Individual provider Active NPI

Michael Russo, M.D.

  • Family Medicine Physician
  • Marrero, LA
National Provider Identifier
1194887125
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21692 Issued in LA
Practice address
1111 Medical Center Blvd
Suite S-555
Marrero, LA 70072-3151
Phone
(504) 349-6808
Fax
(504) 349-6811
NPI assigned
Dec 15, 2006
Last updated
May 20, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 21692 LA Primary

Addresses

Primary practice location

1111 Medical Center Blvd
Suite S-555
Marrero, LA 70072-3151

Mailing address

1111 Medical Center Blvd
Suite S-555
Marrero, LA 70072-3151
Phone (504) 349-6808

Other identifiers 1

IdentifierTypeStateIssuer
1987051MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20050112000899 LA Practitioner - Family Practice 9830148246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in New Orleans, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1111 Med Ctr Blvd
Suite S555
Marrero, LA 70072-3164
Phone (504) 367-8577

1111 Medical Ctr Blvd
Marrero, LA 70072-3151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21692LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michael G Russo MD a Professionsl LLC Family Medicine CurrentSince Nov 1, 2007 Accepting new patients
Westbank Nephrology, Apmc Past Accepting new patients
Southern Surgical Specialists, LLC PastSince Jul 16, 2012 Accepting new patients
West Jefferson Holdings, LLC Past Accepting new patients
Bridgepoint Healthcare Louisiana LLC Past Accepting new patients
Priority Group Holdings, L.L.C. Past Accepting new patients
STM Ventures LLC Past Accepting new patients

Locations

1111 Medical Center Blvd
Ste 555
Marrero, LA 70072
Phone (504) 349-6808

1111 Medical Center Blvd
Ste S555
Marrero, LA 70072
Phone (504) 349-6808

Organizations & group practices 7

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1194887125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE S-555",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6808",
            "fax_number": "504-349-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE S-555",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6808",
            "fax_number": "504-349-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "21692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1987051",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

Sources for this page

Verify at the official NPI Registry.