NPIMap

Individual provider Active NPI

Mark Steven Russo, MD, PHD

  • Nephrology Physician
  • Naples, FL
National Provider Identifier
1316934326
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
83306 Issued in FL
Practice address
878 109TH Ave N
Naples, FL 34108-1821
Phone
(239) 513-1002
Fax
(239) 513-1915
NPI assigned
Oct 4, 2005
Last updated
Sep 11, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 83306 FL Primary

Addresses

Primary practice location

878 109TH Ave N
Naples, FL 34108-1821

Mailing address

878 109TH Ave N
Naples, FL 34108-1821
Phone (239) 513-1002

Other identifiers 2

IdentifierTypeStateIssuer
13594OtherFLBLUE CROSS BLUE SHIELD
263246200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20060822000018 FL Practitioner - NephrologyPractitioner - Internal Medicine 5698755106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
State University of New York Downstate Medical Center, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Naples Nephrology P aGroup PAC ID 6507842010, 6 clinicians

Practice addresses (Care Compare)

2700 Immokalee Rd
Suite 22
Naples, FL 34110-1436
Phone (239) 513-1002

878 109TH Ave N
Naples, FL 34108-1814
Phone (239) 513-1002

878 109TH Ave No
Naples, FL 34108-1814

878 109TH N Ave
Naples, FL 34108-1814

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83306FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Naples Nephrology P a CurrentSince Jan 11, 2002 Accepting new patients
Northeast Kidney Care LLC Nephrology PastSince Apr 1, 2024 Accepting new patients
Major Hospital Past Accepting new patients
Usrc Mustang Dialysis, LLC PastSince May 11, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Ocean Renal Associates, P.a. PastSince Jul 17, 2006 Accepting new patients
North Naples Dialysis LLC PastSince Jan 25, 2008 Accepting new patients

Locations

878 109th Ave N
Naples, FL 34108
Phone (239) 513-1002

878 109th Ave N
#2
Naples, FL 34108
Phone (239) 513-1002

878 109th Ave N
Ste 2
Naples, FL 34108

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 8

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 9

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": "1378857600000",
    "number": "1316934326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "878 109TH AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341081821",
            "telephone_number": "239-513-1002",
            "fax_number": "239-513-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 109TH AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341081821",
            "telephone_number": "239-513-1002",
            "fax_number": "239-513-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MARK",
        "middle_name": "STEVEN",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "83306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "13594",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263246200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.