Russell R Otto, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004505 Issued in CT

Practice address

201 Boston Post Rd
Waterford, CT 06385

Phone

(860) 442-0407

Fax

(860) 444-2015

NPI assigned

Jul 26, 2006

Sex

Male

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 CT

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

Specialty

Physician Assistant

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear,Nose and Throat Associates of Southeastern Connecticut, P.C.Group PAC ID 3678607470, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007

Merit-based Incentive Payment System (MIPS)

Final score

94.01 of 100Reported as group

Quality

98.76

Improvement activities

40

Cost

81.69

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Ear,Nose and Throat Associates of Southeastern Connecticut, P.C.

  • Otolaryngology Physician
  • Waterford, CT
  • NPI 1518044395
  Medicare reassignment Care Compare group
• Adirondack Radiology Associates, P.C.

  dba Adirondack Radiology Albany

  • Diagnostic Radiology Physician
  • Queensbury, NY
  • NPI 1366437014
  NPD (past)
• Whitney M. Young Jr. Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, NY
  • NPI 1942660105
  NPD (past)

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

• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1073530879
  Care Compare affiliation
• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1700092459
  Care Compare affiliation

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572307200000",
    "number": "1346264215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 BOSTON POST RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063852805",
            "telephone_number": "860-442-0407",
            "fax_number": "604-442-0158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BOSTON POST RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-442-0407",
            "fax_number": "860-444-2015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Broad Street Plz",
            "address_2": "Adirondack ENT",
            "address_purpose": "LOCATION",
            "city": "Glens Falls",
            "state": "NY",
            "postal_code": "128014363",
            "country_code": "US",
            "telephone_number": "518-926-1380",
            "fax_number": "518-926-1385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTTO",
        "first_name": "RUSSELL",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2019-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "004505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Oleary, DMD
• Olsl Crossroads Place, LLC
• Optometric Associates,P.C
• Orthodontic Associates of Southeastern Connecticut, P.C.
• Dena Marie Otrin, LPC
• Mindy M Pacileo
• Kimberly Palmer, MA, CCC-SLP
• Mira Patel, LCSW
• Bruce H Patterson, DMD
• Peaceful Connections, LLC

• Physician Assistant in Waterford, CT
• Providers in Waterford, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; 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.