Michael J Russo, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

34635 Issued in CA

Practice address

20301 SW Acacia St Ste 150
Newport Beach, CA 92660-1741

Phone

(949) 274-9551

Fax

(949) 264-8219

NPI assigned

Jan 18, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mike J Russo Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellness Tribe Physical Therapy IncGroup PAC ID 9234586454, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wellness Tribe Physical Therapy Inc

  • Physical Therapist
  • Irvine, CA
  • NPI 1215689880
  Medicare reassignment Care Compare group NPD
• Rising Sun Physical Therapy & Wellness

  • Physical Therapy Clinic/Center
  • Newport Beach, CA
  • NPI 1881003440
  Medicare reassignment
• Interface Rehab, Inc.

  • Physical Disabilities Residential Treatment Facility
  • Placentia, CA
  • NPI 1306960851
  NPD (past)

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585267200000",
    "number": "1265737563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20301 SW ACACIA ST STE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601741",
            "telephone_number": "949-274-9551",
            "fax_number": "949-264-8219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20301 SW ACACIA ST STE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601741",
            "telephone_number": "949-274-9551",
            "fax_number": "949-264-8219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-18",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "34635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKE",
            "last_name": "RUSSO",
            "middle_name": "J",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Savanna Lilliana Ruiz
• Deborah Kay Ruprecht, DDS
• Victor Rusenescu, DPT
• Natalie Russell
• Rachel Ann Russell, RN, RNFA
• Cynthia Lee Ruszat, AGACNP-BC
• Rutland Medical Group
• Karli Nicole Rutledge
• RX Experts Inc
• Ryan Samuelian Chiropractic Corp (Back To Basics Health and Wellness)

• Orthopedic Physical Therapist in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Orthopedic Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.