NPIMap

Individual provider Active NPI

Randolph B Russo, MD

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
National Provider Identifier
1306833470
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
4301056466 Issued in MI
Practice address
1111 Leffingwell Ave NE
Grand Rapids, MI 49525-6406
Phone
(616) 459-7101
Fax
(616) 464-6170
NPI assigned
Oct 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 4301056466 MI Primary

Addresses

Primary practice location

1111 Leffingwell Ave NE
Grand Rapids, MI 49525-6406

Mailing address

1111 Leffingwell Ave NE
Grand Rapids, MI 49525-6406
Phone (616) 459-7101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040102000791 MI Practitioner - Physical Medicine and Rehabilitation 8325942352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Wayne State University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

1111 Leffingwell Ave NE
Grand Rapids, MI 49525-6406
Phone (616) 459-7101

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.51 of 100Reported as group
Quality
49.04
Promoting interoperability
96
Improvement activities
40
Cost
82.67

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates of Grand Rapids, PC CurrentSince Jul 1, 2005 Accepting new patients
Orthopaedic Associates of Grand Rapids PC CurrentSince Jul 1, 2005 Accepting new patients

Locations

1111 Leffingwell Ave NE
Ste 300
Grand Rapids, MI 49525

1111 Leffingwell Ave NE
Ste 100
Grand Rapids, MI 49525
Phone 61645971011381

230 Michigan St NE
Ste 300
Grand Rapids, MI 49503

1111 Leffingwell Ave NE
Grand Rapids, MI 49525
Phone 61645971011381

750 E Beltline Ave NE
Ste 301
Grand Rapids, MI 49525
Phone (616) 913-0138

Interoperability endpoints

  • Direct secure messaging: randolph.russo.p1@direct.oam.nextgenshare.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1306833470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 LEFFINGWELL AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256406",
            "telephone_number": "616-459-7101",
            "fax_number": "616-464-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 LEFFINGWELL AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256406",
            "telephone_number": "616-459-7101",
            "fax_number": "616-464-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "RANDOLPH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301056466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.