Active NPI
Samantha Russo
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1760260772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 11220 Elm LN Ste 102
Charlotte, NC 28277-0716 - Phone
- (704) 847-4000
- Fax
- (704) 847-4001
- NPI assigned
- Sep 20, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
11220 Elm LN Ste 102
Charlotte, NC 28277-0716
Mailing address
6021 Rexwood PL
Charlotte, NC 28210-4047
Phone (919) 619-2623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Medical University of South Carolina College of Medicine, 2023
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
11220 Elm LN
Suite 102
Charlotte, NC 28277-0716
Phone (704) 943-5075
2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Family Healthcare, PA | Current | Accepting new patients |
Locations
11220 Elm Ln
Ste 102
Charlotte, NC 28277
Phone (704) 847-4000
Interoperability endpoints
- samantha.russo.1@4412.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Charlotte, NC
- NPI 1548529878
-
- Physical Therapist
- Gastonia, NC
- NPI 1407932775
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778198400000",
"number": "1760260772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6021 REXWOOD PL",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282104047",
"telephone_number": "919-619-2623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11220 ELM LN STE 102",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282770716",
"telephone_number": "704-847-4000",
"fax_number": "704-847-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-20",
"last_updated": "2026-05-08",
"certification_date": "2026-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2026; 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.