Russell R Addeo, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5570 Issued in FL

Practice address

3901 University Blvd S
Jacksonville, FL 32216-4312

Phone

(904) 858-7216

Fax

(904) 858-7255

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Rehabilitation Hospital, Inc.Group PAC ID 4284664954, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Genesis Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Jacksonville, FL
  • NPI 1912947748
  Medicare reassignment Care Compare group NPD
• Genesis Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Jacksonville, FL
  • NPI 1376114413
  NPD

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425340800000",
    "number": "1689698144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11735 GLACIER BAY DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322562989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164312",
            "telephone_number": "904-858-7216",
            "fax_number": "904-858-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDEO",
        "first_name": "RUSSELL",
        "middle_name": "R",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2015-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5570",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY5570",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adaron Food Group LLC
• Mohammad Adawi, MD
• Add to Life Adult Day Care, Inc.
• Add to Life Adult Day Care, Inc.
• Add to Life Adult Day Care, Inc.
• Taylor Addeo
• Addictions-the Cure Inc
• Johneshia Addison
• Cedrick Ducarmel Ade
• Courtney April Ade, MSW, LCSW

• Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.