NPIMap

Individual provider Active NPI

Daniel Alexander Russo, MD

  • Family Medicine Physician
  • Lititz, PA
National Provider Identifier
1740718212
Registry record updated Jun 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD468073 Issued in PA
Practice address
562 W 2ND Ave
Lititz, PA 17543-1816
Phone
(717) 626-2167
NPI assigned
May 30, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT213545 PA
Family Medicine Physician 207Q00000X MD468073 PA Primary

Addresses

Primary practice location

562 W 2ND Ave
Lititz, PA 17543-1816

Mailing address

562 W 2ND Ave
Lititz, PA 17543-1816
Phone (717) 626-2167

Other practice location 1

51 Peters Rd
Lititz, PA 17543-7685
Phone (717) 626-2167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200917000794 PA Practitioner - Family Practice 5698048924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lancaster General Medical GroupGroup PAC ID 0941103683, 590 clinicians

Practice addresses (Care Compare)

51 Peters Rd
Suite 201
Lititz, PA 17543-7685
Phone (717) 626-0238

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group CurrentSince Aug 20, 2020 Accepting new patients
Lancaster General Medical Group Family Medicine CurrentSince Aug 20, 2020 Accepting new patients
Lancaster General Medical Group Current Accepting new patients
Lancaster General Medical Group Family Medicine Past Accepting new patients

Locations

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

562 W 2nd Ave
Lititz, PA 17543
Phone (717) 626-2167

51 Peters Rd
Ste 201
Lititz, PA 17543
Phone (717) 544-6260

51 Peters Rd
Lititz, PA 17543
Phone (717) 627-2400

Interoperability endpoints

  • Direct secure messaging: drusso201794@direct-lghealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592092800000",
    "number": "1740718212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 W 2ND AVE",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175431816",
            "telephone_number": "717-626-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 W 2ND AVE",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175431816",
            "telephone_number": "717-626-2167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 Peters Rd",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175437685",
            "country_code": "US",
            "telephone_number": "717-626-2167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "DANIEL",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-30",
        "last_updated": "2020-06-14",
        "certification_date": "2020-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT213545",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD468073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lititz, PA

Sources for this page

Verify at the official NPI Registry.