Simon R Russin, DO

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

OS009908L Issued in PA

Practice address

301 E City Ave
Suite G2
Bala Cynwyd, PA 19004-1708

Phone

(610) 617-4177

Fax

(610) 617-4170

NPI assigned

Jun 27, 2005

Last updated

May 31, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Ophthalmology

Education

Philadelphia College of Osteopathic Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Russin Eye LLC

  • Ophthalmology Physician
  • Bala Cynwood, PA
  • NPI 1720255508
  Authorized official Same address or phone
• Roth & Russin LLC

  dba Main Line Eye Specialists

  • Optometrist
  • Wayne, PA
  • NPI 1578587911
  NPD (past)
• Roth and Russin LLC

  dba Main Line Eye Specialists

  • Ophthalmology Physician
  • Wayne, PA
  • NPI 1891781381
  NPD (past)

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1407852049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E CITY AVE",
            "address_2": "SUITE G2",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041708",
            "telephone_number": "610-617-4177",
            "fax_number": "610-617-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E CITY AVE",
            "address_2": "SUITE G2",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041708",
            "telephone_number": "610-617-4177",
            "fax_number": "610-617-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSIN",
        "first_name": "SIMON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "OS009908L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001697374",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10935353",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eliseo Rozenwasser, MFT
• RTC USA LLC
• Tracy Adkins Ruff
• Danielle Ruiz, LPC
• Tamar Runyan, PSYD
• Jeffrey Adam Ruth, PT, DPT
• Colleen Patricia Rygiel, M.S. CCC-SLP
• John George Sacco
• David Morton Sachs, M.D.
• Janet Sandell Sachs, PHD

• Ophthalmology Physician in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Ophthalmology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; 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.