Individual provider Active NPI

John Russin, M.D.

  • Plastic Surgery Physician
  • Hollywood, FL
National Provider Identifier
1376663112
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
139224 Issued in NY
Practice address
2734 Polk St
Hollywood, FL 33020-4832
Phone
(954) 437-2000
NPI assigned
Mar 29, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 139224 NY Primary

Addresses

Primary practice location

2734 Polk St
Hollywood, FL 33020-4832

Mailing address

1 Atwell Rd
Cooperstown, NY 13326-1301
Phone (607) 547-7665

Other practice location 1

1 Atwell Rd
Cooperstown, NY 13326-1301
Phone (607) 547-7665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090429000450 NY Practitioner - Plastic and Reconstructive Surgery 0840348959

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Albany Medical College of Union University, 1978
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Atwell Rd
Cooperstown, NY 13326-1394

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.62 of 100Reported as apm
Quality
77.97
Promoting interoperability
98
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.62 of 100Reported as apm
Quality
77.97
Promoting interoperability
98
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.62 of 100Reported as apm
Quality
77.97
Promoting interoperability
98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
139224NYMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Imogene Bassett Hospital Past Accepting new patients

Organizations & group practices 1

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.

Hospital & facility affiliations 3

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": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1376663112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ATWELL RD",
            "city": "COOPERSTOWN",
            "state": "NY",
            "postal_code": "133261301",
            "telephone_number": "607-547-7665",
            "fax_number": "607-547-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2734 POLK ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330204832",
            "telephone_number": "954-437-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Atwell Rd",
            "address_purpose": "LOCATION",
            "city": "Cooperstown",
            "state": "NY",
            "postal_code": "133261301",
            "country_code": "US",
            "telephone_number": "607-547-7665",
            "fax_number": "607-547-7662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSIN",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NY",
            "license": "139224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.