Martin T Russo Jr., DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101014183 Issued in MI

Practice address

1310 Wisconsin Ave Ste 103
Grand Haven, MI 49417

Phone

(616) 846-2640

Fax

(616) 846-3110

NPI assigned

Aug 8, 2006

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 MI

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

Family Practice

Education

Midwestern University, Chicago College of Osteopathic Med, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Physician NetworkGroup PAC ID 8921996307, 109 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13864/brand/1/csg/1/fhir/r4
• Direct secure messaging: mrusso26241@direct.trinity-health.org

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.

• Mercy Physician Network

  • Family Medicine Physician
  • Muskegon, MI
  • NPI 1023056744
  Medicare reassignment Care Compare group NPD
• Noch Physician Billing Company LLC

  • Family Medicine Physician
  • Grand Haven, MI
  • NPI 1972550580
  Medicare reassignment NPD
• Mercy Physician Network

  • Family Medicine Physician
  • Fruitport, MI
  • NPI 1639502701
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health Partners

  • General Acute Care Hospital
  • Muskegon, MI
  • NPI 1831132133
  Care Compare affiliation

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1508876236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE",
            "address_2": "STE 101",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172472",
            "telephone_number": "616-847-5604",
            "fax_number": "616-846-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE STE 103",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "49417",
            "telephone_number": "616-846-2640",
            "fax_number": "616-846-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MARTIN",
        "middle_name": "T",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101014183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4094275",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Stewart Rouwhorst, M.D.
• Denise Janzen Rowland, RBT
• Sheryl Jane Rozema, PH.D., LLP
• Ronda Victoria Ruscett, OD
• Zoie Theodora Russell
• Donald Ezra Rutherford, D.O.
• Jean Marie Rutherford, LMSW
• RX Optical Laboratories, Inc.
• Ryan Klanseck, DO
• Christine Mary Ryan, D.O.

• Family Medicine Physician in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; 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.