Michael Anthony Russo, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A125016 Issued in CA

Practice address

1811 Brookfurst St #5600
Fountain Valley, CA 92708-6728

Phone

(714) 861-4666

Fax

(714) 861-4682

NPI assigned

Jul 5, 2007

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

Other identifiers 2

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

Specialty

General Surgery

Education

Toledo Medical College, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Leport Surgical Medical CorporationGroup PAC ID 8123012515, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Leport Surgical Medical Corporation

  • Specialist
  • Fountain Valley, CA
  • NPI 1194940015
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1700084381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 BROOKFURST ST #5600",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-861-4666",
            "fax_number": "714-861-4682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 BROOKFURST ST #5600",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-861-4666",
            "fax_number": "714-861-4682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-05",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "Q1013",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A125016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV BOARD OF PHARM",
            "identifier": "ASO2532199374",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV MEDICAL LICENSE",
            "identifier": "LL1802",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell P Rapoza M D a Professional Corporation
• Danielle Marie Russell
• Kendal Corrine Russell
• Kim Russell, PHARMD
• R. Denis Russell, D.P.M.
• Ryan W Jamison DO Inc
• Brenda Jean Ryan, NP
• Lauren Elizabeth Ryder
• Sachin R Sabhlok
• Jennifer Georgia Lynn Sabovich, RN

• Surgery Physician in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.