Individual provider Active NPI

John M Russo, MD

  • Internal Medicine Physician
  • Greensboro, NC
National Provider Identifier
1215957303
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9901465 Issued in NC
Practice address
2703 Henry St
Greensboro, NC 27405-3669
Phone
(336) 621-8911
Fax
(336) 621-6322
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9901465 NC Primary

Addresses

Primary practice location

2703 Henry St
Greensboro, NC 27405-3669

Mailing address

PO Box 14944
Greensboro, NC 27415-4944
Phone (336) 621-8911

Other identifiers 1

IdentifierTypeStateIssuer
891280FMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041228000520 NC Practitioner - Internal Medicine 7810954252 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of Ny Upstate Medical University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Guilford Medical Associates PAGroup PAC ID 9537197231, 11 clinicians

Practice addresses (Care Compare)

2703 Henry St
Greensboro, NC 27405-3669
Phone (336) 621-8911

Hospital & facility affiliations

  • Gentiva Health Services Home health agency, Greensboro, NC, CCN 347075
  • Authoracare Collective Hospice, Greensboro, NC, CCN 341503
  • Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Guilford Medical Associates PA Internal Medicine CurrentSince Sep 1, 2002 Accepting new patients
Medical Resource Management Past Accepting new patients
Choice Consulting Services, PLLC Internal Medicine PastSince Sep 1, 2002 Accepting new patients

Locations

2703 Henry St
#200
Greensboro, NC 27405
Phone (233) 637-5842

2703 Henry St
Greensboro, NC 27405
Phone (336) 621-8911

Interoperability endpoints

  • Direct secure messaging: john.russo@guilmed.eclinicaldirectplus.com

Organizations & group practices 3

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 3

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215957303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14944",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274154944",
            "telephone_number": "336-621-8911",
            "fax_number": "336-621-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2703 HENRY ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274053669",
            "telephone_number": "336-621-8911",
            "fax_number": "336-621-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9901465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891280F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.