Active NPI
John Russin, M.D.
- Plastic Surgery Physician
- Hollywood, FL
National Provider Identifier
1376663112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 139224
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 100
- Quality
- 77.97
- Promoting interoperability
- 98
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.62 of 100
- Quality
- 77.97
- Promoting interoperability
- 98
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.62 of 100
- Quality
- 77.97
- Promoting interoperability
- 98
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Mastectomy | 1-10 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 139224 | NY | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New 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.
-
- Rural Acute Care Hospital
- Cooperstown, NY
- NPI 1780600577
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Cobleskill, NY
- NPI 1689741985
-
- Critical Access Hospital
- Cobleskill, NY
- NPI 1891862579
-
- Rural Acute Care Hospital
- Cooperstown, NY
- NPI 1780600577
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.