Antoinette Marie Russolello, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

029069 Issued in NY

Practice address

370 Bassett Rd
North Haven, CT 06473-4201

Phone

(845) 214-6736

NPI assigned

Oct 25, 2022

Sex

Female

Sole proprietor

Yes

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 NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: antoinette.russolello@ghuc.eclinicaldirectplus.com

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.

• North Shore Lij, Urgent Care, P.C.

  • Urgent Care Clinic/Center
  • Rockville Centre, NY
  • NPI 1679970891
  Medicare reassignment Care Compare group
• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1750008207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 BASSETT RD",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064734201",
            "telephone_number": "845-214-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 BASSETT RD",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064734201",
            "telephone_number": "845-214-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOLELLO",
        "first_name": "ANTOINETTE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "029069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Rosa, LMSW
• Kim Ross, LADC
• John M Roy, APRN
• Francis Ruiz, MD
• Armand Russo, M.D.
• Robert Edward Rybczyk, PHARMACIST
• Varsha Salani, DMD
• Anthony Agtane Salonga
• Stephen Samela, BCBA
• Crystal Sanders, LPC

• Physician Assistant in North Haven, CT
• Providers in North Haven, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.