NPIMap

Individual provider Active NPI

Romolo Harris Russo, M.D.

  • Neurological Surgery Physician
  • Kalamazoo, MI
National Provider Identifier
1821030214
Registry record updated Jun 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
4301036631 Issued in MI
Practice address
601 John St
Suite M-170
Kalamazoo, MI 49007-5341
Phone
(269) 343-3939
Fax
(269) 343-3948
NPI assigned
Jun 12, 2006
Last updated
Jun 14, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 4301036631 MI Primary

Addresses

Primary practice location

601 John St
Suite M-170
Kalamazoo, MI 49007-5341

Mailing address

601 John St
Suite M-170
Kalamazoo, MI 49007-5341
Phone (269) 343-3939

Other identifiers 4

IdentifierTypeStateIssuer
4832089-10MedicaidMI
4325832OtherAETNA PIN
155407OtherGREAT LAKES HLTH PLN
1403912121OtherMIBCBS PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301036631MIMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest, PC PastSince Apr 1, 2006 Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients
Healthcare Midwest PC Past Accepting new patients

Organizations & group practices 8

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.

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": "1276473600000",
    "number": "1821030214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE M-170",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-343-3939",
            "fax_number": "269-343-3948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE M-170",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-343-3939",
            "fax_number": "269-343-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "ROMOLO",
        "middle_name": "HARRIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "4301036631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4832089-10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "4325832",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HLTH PLN",
            "identifier": "155407",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "1403912121",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.