Individual provider Active NPI

Alyse Cortney Russo, MPAS, PA-C

  • Physician Assistant
  • Teaneck, NJ
National Provider Identifier
1346516408
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00279700 Issued in NJ
Practice address
870 Palisade Ave
Suite 302
Teaneck, NJ 07666-3419
Phone
(201) 836-9696
NPI assigned
Mar 22, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00279700 NJ Primary

Addresses

Primary practice location

870 Palisade Ave
Suite 302
Teaneck, NJ 07666-3419

Mailing address

16 Rainbow TRL
Denville, NJ 07834-3208
Phone (973) 462-9455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20171031003172 NJ Practitioner - Physician Assistant 6901172238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Natural Image Skin CenterGroup PAC ID 1557502390, 9 clinicians

Practice addresses (Care Compare)

108 Bilby Rd
Hackettstown, NJ 07840-4174
Phone (908) 509-1938

Merit-based Incentive Payment System (MIPS)

Final score
85.75 of 100Reported as group
Quality
76.52
Promoting interoperability
100
Improvement activities
40
Cost
75.97

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00279700NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Radiology Group of New Jersey, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423440000000",
    "number": "1346516408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 RAINBOW TRL",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078343208",
            "telephone_number": "973-462-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 PALISADE AVE",
            "address_2": "SUITE 302",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663419",
            "telephone_number": "201-836-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "ALYSE",
        "middle_name": "CORTNEY",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-22",
        "last_updated": "2015-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00279700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.