Individual provider Active NPI

Amy Lynn Russell, PA

  • Physician Assistant
  • Camillus, NY
National Provider Identifier
1376788588
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
012926 Issued in NY
Practice address
5417 W Genesee St Ste 3
Camillus, NY 13031-2177
Phone
(315) 476-2323
NPI assigned
Dec 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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 012926 NY Primary

Addresses

Primary practice location

5417 W Genesee St Ste 3
Camillus, NY 13031-2177

Mailing address

1001 W Fayette St Ste 400
Syracuse, NY 13204-2866
Phone (315) 937-3433

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address arussell@crousemed.medentdirect.com Direct Crouse Medical Practice, PLLC

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090304000488 NY Practitioner - Physician Assistant 3274699954 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Crouse Medical Practice PLLCGroup PAC ID 8426189622, 187 clinicians

Practice addresses (Care Compare)

5417 W Genesee St
Camillus, NY 13031-2176
Phone (315) 476-2323

736 Irving Ave
Syracuse, NY 13210-1687
Phone (315) 470-7111

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
  • Crouse Hospital Hospital, Syracuse, NY, CCN 330203
  • University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Crouse Medical Practice, PLLC CurrentSince Aug 26, 2024 Accepting new patients

Locations

5417 W Genesee St
Ste 3
Camillus, NY 13031
Phone (315) 470-7409

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

Interoperability endpoints

  • Direct secure messaging: arussell@crousemed.medentdirect.com

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.

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": "1228262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1376788588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042866",
            "telephone_number": "315-937-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5417 W GENESEE ST STE 3",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312177",
            "telephone_number": "315-476-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-03",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arussell@crousemed.medentdirect.com",
            "affiliation": "Y",
            "endpointDescription": "email address in Medent",
            "affiliationName": "Crouse Medical Practice, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "arussell@crousemed.medentdirect.com",
            "address_1": "5417 W Genesee St Ste 3",
            "city": "Camillus",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130312177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Camillus, NY

Sources for this page

Verify at the official NPI Registry.