Individual provider Active NPI

Olivia Russo

  • Physical Therapist
  • Palm Desert, CA
National Provider Identifier
1558908475
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
75100 Mediterranean
Palm Desert, CA 92211-9069
Phone
(760) 837-0033
Fax
(760) 837-1013
NPI assigned
Dec 10, 2019
Last updated
Jun 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X CA Primary

Addresses

Primary practice location

75100 Mediterranean
Palm Desert, CA 92211-9069

Mailing address

75100 Mediterranean
Palm Desert, CA 92211-9069
Phone (760) 837-0033

Other identifiers 1

IdentifierTypeStateIssuer
1124434261OtherCAEMPLOYER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250718001738 NY Practitioner - Physical Therapist in Private Practice 1951732643 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

77 Medford Ave
Patchogue, NY 11772-1281
Phone (631) 758-1910

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
045226NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jul 7, 2025 Accepting new patients
Easy Speech Pathology, Inc. CurrentSince May 7, 2020 Accepting new patients
New York University CurrentSince Jul 7, 2025 Accepting new patients
Easy Speech Therapy Center PastSince Dec 1, 2019 Accepting new patients
Nyumc Radiology Associates Past Accepting new patients

Locations

1007 E Cooley Dr
Ste 107
Colton, CA 92324
Phone (760) 837-0033

41555 Cook St
Ste 100
Palm Desert, CA 92211
Phone (760) 837-0033

75100 Mediterranean
Palm Desert, CA 92211
Phone (760) 340-9832

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

77 Route 112
Patchogue, NY 11772
Phone (631) 207-2370

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

877 E Main St
Ste 106
Riverhead, NY 11901
Phone (631) 727-0660

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1558908475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75100 MEDITERRANEAN",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922119069",
            "telephone_number": "760-837-0033",
            "fax_number": "760-837-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75100 MEDITERRANEAN",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922119069",
            "telephone_number": "760-837-0033",
            "fax_number": "760-837-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "OLIVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-10",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYER",
            "identifier": "1124434261",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.