Russell Anthony Pecoraro, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME97791 Issued in FL

Practice address

2023 Professional Center Dr
Orange Park, FL 32073-4468

Phone

(904) 272-2020

NPI assigned

Sep 29, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harris Wilcox and Donovan PAGroup PAC ID 4981776333, 17 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rpecoraro@clayeye.emadirect.md

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

• Harris Wilcox and Donovan PA

  • Ophthalmology Physician
  • Orange Park, FL
  • NPI 1023120409
  Medicare reassignment Care Compare group NPD
• Harris Wilcox and Donovan PA

  • Ophthalmology Physician
  • Middleburg, FL
  • NPI 1659963205
  NPD
• East West Anesthesia LLC

  • Anesthesiology Physician
  • Fleming Island, FL
  • NPI 1194435651
  NPD (past)

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491350400000",
    "number": "1891887394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 PROFESSIONAL CENTER DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734468",
            "telephone_number": "904-272-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 PROFESSIONAL CENTER DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734468",
            "telephone_number": "904-272-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECORARO",
        "first_name": "RUSSELL",
        "middle_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2017-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME97791",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "R0838",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100007660",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Craig Pearson, M.D.
• Harold William Pearson, M.D.
• Marilyn Pearson, DDS
• Richard A Pearson, DDS
• Julie Peckham
• John P Peden, DDS
• Mackenzie Pederson
• Pediatrix Medical Group of Florida Inc
• Pediatrix Medical Group of Florida, Inc
• Amy Jean Pelletier, MPT

• Ophthalmology Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; 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.