Jill M. Russom, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A71632 Issued in CA

Practice address

12586 Avenue
Orosi, CA 93647-9454

Phone

(559) 528-2804

Fax

(559) 528-7623

NPI assigned

Jan 27, 2006

Last updated

Mar 27, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

State licenses

Practice roles

Locations

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.

• Community Foundation Medical Group

  dba Sante' Foundation Medical Group

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1811258510
  Medicare reassignment NPD
• Community Foundation Medical Group

  dba Sante' Foundation Medical Group

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1003329491
  NPD
• Community Foundation Medical Group

  dba Sante' Foundation Medical Group

  • Orthopaedic Surgery Physician
  • Fresno, CA
  • NPI 1376056721
  NPD
• 1Lab Inc.

  • Clinical Medical Laboratory
  • Fresno, CA
  • NPI 1992631261
  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332806400000",
    "number": "1639140791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 EAST CENTER AVE.",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916331",
            "telephone_number": "559-737-4700",
            "fax_number": "559-737-4782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12586 AVENUE",
            "city": "OROSI",
            "state": "CA",
            "postal_code": "936479454",
            "telephone_number": "559-528-2804",
            "fax_number": "559-528-7623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOM",
        "first_name": "JILL",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2012-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A71632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alejandra Reyna Martin
• Benito Rivas Jr., PA-C
• Tasha Justine Rivera, PPS
• Jennifer Robledo Vargas
• Flora Rodriguez, PA-C
• Alberto Ruvalcaba, M.D.
• Daniel Hany Ibrahim Said, DDS
• San Joaquin Family Healthcare Association, Inc (OROSI Family Medical Care)
• Gary Haro Sanchez, MS, PPS, LEP
• Mayra Sandoval

• Family Medicine Physician in Orosi, CA
• Providers in Orosi, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.