Mara A Bazdaric-Russell, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

336641 Issued in NY

Practice address

12 Elm St
Potsdam, NY 13676-2166

Phone

(315) 353-2572

Fax

(315) 353-2479

NPI assigned

Mar 1, 2011

Last updated

Jul 22, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain Medical Primary Care, PLLC

  • Specialist
  • Lake Placid, NY
  • NPI 1427100262
  Medicare reassignment NPD
• St Regis Mohawk Tribe

  dba St Regis Mohawk Health Services

  • Federally Qualified Health Center (FQHC)
  • Akwesasne, NY
  • NPI 1457344558
  Medicare reassignment NPD
• Statline Medical PC

  • Internal Medicine Physician
  • Cortlandt Manor, NY
  • NPI 1942872759
  Medicare reassignment NPD
• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782
  Medicare reassignment
• Michael PM Pond, MD

  • Emergency Medicine Physician
  • Lake Placid, NY
  • NPI 1962472514
  Medicare reassignment
• Beach Medical Services

  • Primary Care Clinic/Center
  • Plattsburgh, NY
  • NPI 1881078079
  NPD (past)
• Mountain Medical Services

  • Specialist
  • Saranac Lake, NY
  • NPI 1871645705
  NPD (past)

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

{
    "created_epoch": "1298937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1316245236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ELM ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136762166",
            "telephone_number": "315-353-2572",
            "fax_number": "315-353-2479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 LeRoy St",
            "address_purpose": "LOCATION",
            "city": "Potsdam",
            "state": "NY",
            "postal_code": "136761786",
            "country_code": "US",
            "telephone_number": "315-261-5954",
            "fax_number": "315-261-6422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAZDARIC-RUSSELL",
        "first_name": "MARA",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-01",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "336641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie L. Barnes, LMHC
• Danielle Barse, LPN
• Jillian Bartling, D.O.
• Carrie Bascom
• Frank Bateman, RPAC
• Lindsay Beach
• Myriam Nimr Shafik Beniamin, M.D.
• Kimberley J Berg, RN
• Sarah Berube, RD
• Maurice Bettez, M.D.

• Family Nurse Practitioner in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.