Anthony Russo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G19800 Issued in CA

Practice address

219 20TH Ave
Santa Cruz, CA 95062-4953

Phone

(650) 483-7703

NPI assigned

May 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670630400000",
    "number": "1831148287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 20TH AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950624953",
            "telephone_number": "650-483-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 20TH AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950624953",
            "telephone_number": "650-483-7703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 El Camino Real",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Burlingame",
            "state": "CA",
            "postal_code": "94010",
            "country_code": "US",
            "telephone_number": "650-692-7545",
            "fax_number": "650-692-7609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2022-12-10",
        "certification_date": "2022-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "G19800",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G19800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Russell
• James Douglas Russell, MFTI
• Lisa Russell, PH.D.
• Serena Russell, LM, CPM
• Terence P Russell, MA
• Stephen Reed Ruzicka, MFT MPA
• Caroline Ryan, M.D.
• Mary Jean Ryan, PA-C
• Matthew Ryan
• Matthew McLeod Ryan, DO

• Internal Medicine Physician in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2022; 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.