Fredrick Matthew Russo, MD.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C41689 Issued in CA

Practice address

19950 Rinaldi St
Porter Ranch, CA 91326-4141

Phone

(818) 403-2420

Fax

(818) 360-6036

NPI assigned

Jul 18, 2006

Last updated

Apr 3, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: frusso350571@oc.providencedirect.org

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.

• Providence Facey Medical Foundation

  dba Facey Medical Group

  • Internal Medicine Physician
  • Valencia, CA
  • NPI 1710031588
  Medicare reassignment NPD
• Providence Facey Medical Foundation

  dba Providence Express Care

  • Multi-Specialty Clinic/Center
  • Irvine, CA
  • NPI 1891348447
  NPD
• Providence Facey Medical Foundation

  dba Facey Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Mission Hills, CA
  • NPI 1194083824
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396483200000",
    "number": "1457370074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9602",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913469602",
            "telephone_number": "818-837-5691",
            "fax_number": "818-792-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19950 RINALDI ST",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913264141",
            "telephone_number": "818-403-2420",
            "fax_number": "818-360-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "FREDRICK",
        "middle_name": "MATTHEW",
        "credential": "MD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C41689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C416890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rinaldi Pharmacy, Inc.
• Rose Senior Care, Inc.
• Mojdeh Rouhani, PHARMD
• Royal Recovery and Treatment Center
• Jacob Philip Rubin, MD
• Krysta Danielle Russo, BCBA
• Jacob Hyunwoo Ryang
• Michellene Saegh, M.D.
• Navjot Saggar, FNP
• Sanaa Saquib, PHARMD

• Internal Medicine Physician in Porter Ranch, CA
• Providers in Porter Ranch, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.