Jessica Holly Russell, CNM

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

F002033-01 Issued in NY

Practice address

101 Nicolls Rd
Stony Brook, NY 11794-0001

Phone

(631) 444-4000

NPI assigned

Feb 18, 2022

Last updated

May 3, 2022By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: jessica.russell@direct.stonybrookmedicine.edu

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.

• University Associates in Obstetrics & Gynecology, University Faculty P

  • Obstetrics & Gynecology Physician
  • Stony Brook, NY
  • NPI 1538114723
  Medicare reassignment NPD

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

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1891440640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2479 RIVERSIDE DR",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117934543",
            "telephone_number": "631-252-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JESSICA",
        "middle_name": "HOLLY",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "F002033-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.russell@direct.stonybrookmedicine.edu",
            "affiliation": "N",
            "address_1": "101 Nicolls Rd",
            "city": "Stony Brook",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117940001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Deirdre Anne Rubino, MA CCC-SLP
• Dina Michele Rucco, PHARMD
• Richard C Rugen, DC
• E. Victoria Rundberg-Rivera, M.D.
• Geoffrey McMillan Russell, MD
• Christine Elizabeth Russo, CPNP-PC
• Domenick Russo
• Lauren Nicole Russo
• Nicole Marie Russo, MSN, RN, CCRN, CPNP
• Alexandra Rusz, MD

• Obstetrics & Gynecology Physician in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Obstetrics & Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.