Individual provider Active NPI

Craig Russo, MD

  • Diagnostic Radiology Physician
  • Springfield, IL
National Provider Identifier
1790727659
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036095798 Issued in IL
Practice address
3050 Montvale Dr Ste a
Springfield, IL 62704-6924
Phone
(217) 726-8096
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036095798 IL Primary

Addresses

Primary practice location

3050 Montvale Dr Ste a
Springfield, IL 62704-6924

Mailing address

2040 W Iles Ave
Suite C
Springfield, IL 62704-4183
Phone (217) 789-0668

Other identifiers 1

IdentifierTypeStateIssuer
036095798MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20041101000223 IL Practitioner - Diagnostic Radiology 7214999457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Albert Einstein College of Medicine of Yeshiva University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as apm
Quality
75.65
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036095798ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Clinic LLP Current Accepting new patients
Springfield Clinic, LLP CurrentSince Feb 15, 2006 Accepting new patients
Crawford Hospital District Family Medicine Current Accepting new patients
Radiological Associates of Decatur Diagnostic Radiology Past Accepting new patients

Locations

300 N Broad St
Carlinville, IL 62626
Phone (217) 544-2020

1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131

1025 S 7th St
Springfield, IL 62703
Phone (217) 525-7541

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

701 N 1st St
Springfield, IL 62781
Phone (217) 788-3100

1025 S 6th St
Springfield, IL 62703

Interoperability endpoints

  • Direct secure messaging: craig.russo.1@28977.direct.athenahealth.com
  • Direct secure messaging: cruss@yourcarecommunity.org
  • Direct secure messaging: craigrusso@sfc.allscriptsdirect.net

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 5

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438646400000",
    "number": "1790727659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 W ILES AVE",
            "address_2": "SUITE C",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044183",
            "telephone_number": "217-789-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 MONTVALE DR STE A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046924",
            "telephone_number": "217-726-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "CRAIG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2015-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036095798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095798",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.