Amy Gauck Russo, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704302008 Issued in MI

Practice address

655 Kenmoor Ave SE Ste 200
Grand Rapids, MI 49546-8622

Phone

(616) 363-7690

Fax

(616) 942-8917

NPI assigned

Oct 1, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, MI2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Internal Medicine and Pediatrics of West Michigan LLCGroup PAC ID 6305090507, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Merit-based Incentive Payment System (MIPS)

Final score

93.2 of 100Reported as group

Promoting interoperability

92

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: arusso3208168@epic00.corewelldirect.org

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.

• Internal Medicine and Pediatrics of West Michigan

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1104170661
  Medicare reassignment Care Compare group NPD
• Dawm, PLC

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1932132446
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1316619901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 KENMOOR AVE SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468622",
            "telephone_number": "616-363-7690",
            "fax_number": "616-942-8917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 KENMOOR AVE SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468622",
            "telephone_number": "616-363-7690",
            "fax_number": "616-942-8917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "AMY",
        "middle_name": "GAUCK",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-01",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1052618",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704302008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaden Skye Russell, LLBSW
• Kristina Russell, LPC
• Laura Michelle Russell, LMSW
• Megan Ann Russell
• Vanessa Russell
• Christopher Ross Russo, MD
• Randolph B Russo, MD
• Scott S Russo, MD
• Trevor Louis Russo, DO
• Russom Recovery Therapies LLC

• Family Nurse Practitioner in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.
• 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.