Active NPI
Kenneth J Russo, MD
- Otolaryngology Physician
- Scottsdale, AZ
National Provider Identifier
1437129343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 12608
- Practice address
- 9097 E Desert Cove Dr Ste 260
Scottsdale, AZ 85260-6278 - Phone
- (480) 684-1080
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 12608 | AZ | Primary |
Addresses
Primary practice location
9097 E Desert Cove Dr Ste 260
Scottsdale, AZ 85260-6278
Mailing address
9097 E Desert Cove # 260
Scottsdale, AZ 85260
Phone (480) 684-1080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- kenneth.russo@1028.chartlogic.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354579200000",
"number": "1437129343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9097 E DESERT COVE # 260",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "85260",
"telephone_number": "480-684-1080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9097 E DESERT COVE DR STE 260",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852606278",
"telephone_number": "480-684-1080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "KENNETH",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2012-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "AZ",
"license": "12608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scottsdale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.