NPIMap

Individual provider Active NPI

Marc S Russo, M.D.

  • Family Medicine Physician
  • Lititz, PA
National Provider Identifier
1427033927
Registry record updated Sep 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD042622L Issued in PA
Practice address
562 W 2ND Ave
Lititz, PA 17543-1816
Phone
(717) 626-2167
Fax
(717) 626-1915
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD042622L PA Primary

Addresses

Primary practice location

562 W 2ND Ave
Lititz, PA 17543-1816

Mailing address

562 W 2ND Ave
Lititz, PA 17543-1816
Phone (717) 626-2167

Other identifiers 9

IdentifierTypeStateIssuer
578413OtherPAAETNA HMO
P002686OtherPAGATEWAY HEALTH PLAN
G05182OtherPAHEALTH ASSURANCE
02110901OtherPACAPITAL BLUE CROSS
36691 S1QGOtherPAGEISINGER HEALTH PLAN
5487080OtherPAAETNA NON-HMO
775158OtherPAHIGHMARK BLUE SHIELD
0015140170004MedicaidPA
0015140170001MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060109000714 PA Practitioner - Family Practice 8123041811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lancaster General Medical GroupGroup PAC ID 0941103683, 590 clinicians

Practice addresses (Care Compare)

3045 Marietta Ave
Lancaster, PA 17601-1321
Phone (717) 299-4644

51 Peters Rd
Lititz, PA 17543-7685

562 W 2ND Ave
Lititz, PA 17543-1816

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD042622LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group Family Medicine CurrentSince Aug 1, 1995 Accepting new patients
Lancaster General Medical Group Current Accepting new patients
Lancaster General Medical Group CurrentSince Aug 1, 1995 Accepting new patients
Lancaster General Medical Group Family Medicine Past Accepting new patients

Locations

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

562 W 2nd Ave
Lititz, PA 17543
Phone (717) 626-2167

51 Peters Rd
Ste 201
Lititz, PA 17543
Phone (717) 544-6260

Interoperability endpoints

  • Direct secure messaging: mrusso2263@direct-lghealth.org

Organizations & group practices 4

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 8

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": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188604800000",
    "number": "1427033927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 W 2ND AVE",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175431816",
            "telephone_number": "717-626-2167",
            "fax_number": "717-626-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 W 2ND AVE",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175431816",
            "telephone_number": "717-626-2167",
            "fax_number": "717-626-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MARC",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2007-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD042622L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "578413",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY HEALTH PLAN",
            "identifier": "P002686",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "G05182",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02110901",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "36691 S1QG",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5487080",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "775158",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015140170004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015140170001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lititz, PA

Sources for this page

Verify at the official NPI Registry.