Selena Rose Russo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

AMD-1004 Issued in HI

Practice address

99-115 Aiea Heights Dr Ste 276B
Aiea, HI 96701-3924

Phone

(808) 784-3050

Fax

(808) 486-5558

NPI assigned

Dec 1, 2017

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

Other names 1

• Selena Rose Nieto Ballestero Former name

Medicare fee-for-service enrollment

Enrolled in HI

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pacific Vascular Associates LLCGroup PAC ID 9537598859, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

65.15 of 100Reported as group

Quality

16.73

Improvement activities

40

Cost

78.22

Merit-based Incentive Payment System (MIPS)

Final score

70.16 of 100Reported as group

Quality

40

Improvement activities

40

Cost

71.98

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: selena.russo.p1@direct.wcchc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Vascular Associates, LLC

  • Vascular Surgery Physician
  • Aiea, HI
  • NPI 1154888014
  Medicare reassignment Care Compare group
• Evolve Medical Center, LLC

  • Clinic/Center
  • Kailua Kona, HI
  • NPI 1366019143
  NPD (past)

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

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1801300694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99-115 AIEA HEIGHTS DR STE 276B",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967013924",
            "telephone_number": "718-249-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99-115 AIEA HEIGHTS DR STE 276B",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967013924",
            "telephone_number": "808-784-3050",
            "fax_number": "808-486-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "SELENA",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-01",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "HI",
            "license": "AMD-1004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SELENA",
            "last_name": "NIETO BALLESTERO",
            "middle_name": "ROSE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Ruiz
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• Russell T. Ogawa, MD
• Celeste Russell
• Chad Russell, MD
• Ryan N. Sumida M.D. Inc.
• Safe Harbor Homecare, Inc.
• Chrystalline Joy Sagario
• Chace Mitsuo-Kiyoshi Sagawa
• Diandrea Sagisi-Buxton

• Physician Assistant in Aiea, HI
• Providers in Aiea, HI by specialty
• Physician Assistant in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.