Active NPI
Mitchell Russo, DPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1285267617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 297093
- Practice address
- 15004 Innovation Dr
San Diego, CA 92128-3491 - Phone
- (858) 605-7189
- NPI assigned
- Feb 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 297093 | CA | Primary |
Addresses
Primary practice location
15004 Innovation Dr
San Diego, CA 92128-3491
Mailing address
10790 Rancho Bernardo Rd
Mail Drop 4S-205 in Address 2 Box
San Diego, CA 92127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 297093 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Clinic Medical Group | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- San Diego, CA
- NPI 1124003280
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1285267617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10790 RANCHO BERNARDO RD",
"address_2": "MAIL DROP 4S-205 IN ADDRESS 2 BOX",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15004 INNOVATION DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921283491",
"telephone_number": "858-605-7189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "MITCHELL",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-13",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "297093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.