NPIMap

Individual provider Active NPI

Thomas Anthony Russo, PA

  • Medical Physician Assistant
  • Coxsackie, NY
National Provider Identifier
1902804412
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
004434-1 Issued in NY
Practice address
9 Law St
Coxsackie, NY 12192
Phone
(518) 731-2120
Fax
(518) 731-2070
NPI assigned
Jul 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 004434-1 NY Primary

Addresses

Primary practice location

9 Law St
Coxsackie, NY 12192

Mailing address

9 Law St
Coxsackie, NY 12192
Phone (518) 731-2120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060421000037 NY Practitioner - Physician Assistant 8426068313 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Memorial Regional Medical PLLCGroup PAC ID 2567865447, 7 clinicians

Practice addresses (Care Compare)

6171 Route 23a
Tannersville, NY 12485
Phone (518) 589-6843

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
004434NYMDChiropractor
004434-1NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Memorial Hospital CurrentSince Jul 1, 2022 Accepting new patients
Columbia Memorial Hospital CurrentSince Jul 1, 2022 Accepting new patients
Columbia Memorial Health Past Accepting new patients

Locations

24 Lafayette Ave
Coxsackie, NY 12051
Phone (518) 731-6171

71 Prospect Ave
Hudson, NY 12534
Phone (518) 262-3773

2827 US Highway 9
Valatie, NY 12184
Phone (518) 828-7601

9 Law St
West Coxsackie, NY 12192
Phone (518) 435-1400

Interoperability endpoints

  • Direct secure messaging: trusso788864@direct.trinity-health.org
  • Direct secure messaging: trusso102010@albanymed.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1902804412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 LAW ST",
            "city": "COXSACKIE",
            "state": "NY",
            "postal_code": "12192",
            "telephone_number": "518-731-2120",
            "fax_number": "518-731-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 LAW ST",
            "city": "COXSACKIE",
            "state": "NY",
            "postal_code": "12192",
            "telephone_number": "518-731-2120",
            "fax_number": "518-731-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "THOMAS",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "004434-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coxsackie, NY

Sources for this page

Verify at the official NPI Registry.