Tara Russow, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

012305 Issued in NY

Practice address

120 Allens Creek Rd
Rochester, NY 14618-3306

Phone

(585) 442-4447

Fax

(585) 442-7650

NPI assigned

Nov 21, 2006

Last updated

Oct 31, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Michael D. Miran, PH.D. Psychologist P.C.

  • Clinical Psychologist
  • Rochester, NY
  • NPI 1811227671
  NPD (past)
• Quiet Mind Therapy Services, LCSW, PLLC

  • Clinical Social Worker
  • Rochester, NY
  • NPI 1629568381
  NPD (past)
• Senior Citizens Care Group,LLP

  • Clinical Psychologist
  • New York, NY
  • NPI 1639259336
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288483200000",
    "number": "1326113143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 ALLENS CREEK RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146183306",
            "telephone_number": "585-442-4447",
            "fax_number": "585-442-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 ALLENS CREEK RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146183306",
            "telephone_number": "585-442-4447",
            "fax_number": "585-442-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOW",
        "first_name": "TARA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2010-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "012305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01773702",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7004363",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS BCBS",
            "identifier": "P010012305",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2129026",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiera O'Connor Russo
• Sarina Russo
• Thomas J Russo, D.O.
• Alana Russotti
• Justin Russotti, PHD, LCSW
• Kay L Rust, NP
• Wanda Jean Rust, LPN
• Shea Ruster, MS
• Teigan Estelle Ruster, MD
• Iustinian Rusu, M.D.

• Clinical Psychologist in Rochester, NY
• Providers in Rochester, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2010; 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.