Active NPI
Arthur Robert Russo, MD
- Internal Medicine Physician
- Southbridge, MA
National Provider Identifier
1730196205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 49550
- Practice address
- 100 South St
Southbridge, MA 01550-4051 - Phone
- (508) 765-9771
- Fax
- (508) 764-2486
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 49550 | MA | Primary |
Addresses
Primary practice location
100 South St
Southbridge, MA 01550-4051
Mailing address
40 Bentwood Dr
Sturbridge, MA 01566-1129
Phone (508) 347-0999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49550 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49550 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730196205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 BENTWOOD DR",
"city": "STURBRIDGE",
"state": "MA",
"postal_code": "015661129",
"telephone_number": "508-347-0999",
"fax_number": "508-347-2299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SOUTH ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015504051",
"telephone_number": "508-765-9771",
"fax_number": "508-764-2486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ARTHUR",
"middle_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "49550",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "49550",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.