NPIMap

Organization Active NPI

Michael B Russo MD, Inc

Doing business as Honolulu Neuroscience Clinic

  • Specialist
  • Honolulu, HI
National Provider Identifier
1871972232
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD14968 Issued in HI
Legal business name
MICHAEL B RUSSO MD, INC
Doing business as
Honolulu Neuroscience Clinic
Practice address
250 Ward Ave
Suite #170
Honolulu, HI 96814-4015
Phone
(808) 294-3332
NPI assigned
May 19, 2015
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Michael Brian Russo, MDNPI 1477523785
Title
Owner
Phone
(808) 294-3332

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD14968 HI Primary

Addresses

Primary practice location

250 Ward Ave
Suite #170
Honolulu, HI 96814-4015

Mailing address

8513 NE Hazel Dell Ave
Suite #102
Vancouver, WA 98665-8068
Phone (360) 450-3926

Other names 1

  • Honolulu Neuroscience Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150813009389 HI Part B Supplier - Clinic/Group Practice 5496060923 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI

National Provider Directory

National Provider Directory

Locations

250 Ward Ave
Ste 170
Honolulu, HI 96814
Phone (808) 294-3332

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1871972232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8513 NE HAZEL DELL AVE",
            "address_2": "SUITE #102",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658068",
            "telephone_number": "360-450-3926",
            "fax_number": "360-450-3926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 WARD AVE",
            "address_2": "SUITE #170",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968144015",
            "telephone_number": "808-294-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL B RUSSO MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-294-3332",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "HI",
            "license": "MD14968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Honolulu Neuroscience Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Honolulu Neuroscience Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.