ANDREA RUSSO (NPI# 1093244303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093244303 |
| Entity Type | Individual |
| Full Name | ANDREA RUSSO |
| Credential | CRM |
| Practice Address |
5257 Ne Martin Luther King Jr Ste 201 Portland OR 97211-3283 |
| Practice Telephone | (503) 851-0059 |
| Practice Fax Number | 5034305403 |
| Mailing Telephone | 5038510059 |
| Mailing Fax Number | 5034305403 |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2017-06-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 17-CRM-099 | OR | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083190854 | Andrea Russo | Optometrist | 3350 La Jolla Village Dr, San Diego, CA 92161-0002 | 2018-07-16 |
| 1336652056 | Andrea Russo | Audiologist | 1421 3rd Ave Apt 4, New York, NY 10028-1933 | 2017-11-16 |
| 1114442001 | Andrea Russo | Counselor | 286 S Main St Ste 200, Alpharetta, GA 30009-1943 | 2017-08-11 |
| 1073927570 | Andrea Russo | Pharmacist | 933 Pleasant St, Fall River, MA 02723-1000 | 2014-06-12 |
| 1922311307 | Andrea Hoboken Russo | Obstetrics & Gynecology | 51-53 Kenosia Ave, Danbury, CT 06810-2304 | 2010-07-14 |
| 1003043548 | Andrea L Russo | Radiology | 2014 Washington St, Newton, MA 02462-1607 | 2009-06-11 |
| 1841424777 | Andrea Russo | Social Worker | 567 Pleasant St, Brockton, MA 02301-2507 | 2009-05-06 |
| 1396777694 | Andrea M Russo | Internal Medicine | 1 Cooper Plz, 3 Dorrance, Camden, NJ 08103-1461 | 2006-07-07 |
| Street Address |
5257 NE MARTIN LUTHER KING JR STE 201 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97211-3283 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225564180 | Reginal Stroughter | Counselor | 5257 Ne Martin Luther King Jr Ste 201, Portland, OR 97211-3283 | 2017-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386104586 | Rachel Joy Kendall | Counselor | 5257 Nw Martin Luther King Jr. Blvd, 202e, Portland, OR 97211 | 2019-03-22 |
| 1073014601 | Kelli Minton | Behavior Technician | 7035 Ne 9th Ave, Portland, OR 97211 | 2018-02-28 |
| 1083145726 | Warren H Baumann | Registered Nurse | 854 Ne Simpson St, Portland, OR 97211 | 2017-03-24 |
| 1407277411 | Regina Barnett | Case Manager/Care Coordinator | 509 Ne Alberta St., Portland, OR 97211 | 2013-12-17 |
| 1578905964 | Carmel Therese Irving | Social Worker | 5912 Ne 16th Ave, Portland, OR 97211 | 2013-07-25 |
| 1629310990 | Lisa Peacock | Counselor | 4433 Ne 35 Place, Portland, OR 97211 | 2013-03-25 |
| 1285907915 | Michele Karen Koder | Pharmacist | 3529 Ne Martin Luther King, Jr. Blvd., Portland, OR 97211 | 2012-02-10 |
| 1629368196 | Alexis Miranda Barker | Massage Therapist | 4929 Ne 30th Ave, Zen Space Healing, Portland, OR 97211 | 2011-04-18 |
| 1396041760 | Kara Ann Fuerst | Specialist | 3325 Ne Prescott, Portland, OR 97211 | 2011-02-02 |
| 1063746337 | Laura K Elvers | Pharmacist | 6116 Ne Mlk, Portland, OR 97211 | 2009-09-18 |
| Find all providers in zip 97211 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1245896307 | Anthony James Hardy | Peer Specialist | 10336 Ne Wygant St, Portland, OR 97220-3368 | 2019-05-14 |
| 1881155596 | Laray Jermaine Thomas | Peer Specialist | 11509 Se Stephens St, Portland, OR 97216-3660 | 2019-03-26 |
| 1932684248 | Dorothy Joanna Burton | Peer Specialist | 3716 Ne Martin Luther King Blvd, Portland, OR 97212-1111 | 2018-10-02 |
| 1750886255 | Steven Wade | Peer Specialist | 4512 Ne Portland Hwy, Portland, OR 97218-1363 | 2018-03-27 |
| 1669991212 | Kimberly Jaye Randall | Peer Specialist | 17214 Se Division St Ste 2, Portland, OR 97236-1282 | 2017-09-14 |
| 1689103897 | Walter Bulter | Peer Specialist | 5257 Ne Martin Luther King Jr Blvd Ste 202, Portland, OR 97211-3283 | 2017-06-09 |
| 1306373543 | Brenda Kay Mitchell | Peer Specialist | 10373 Ne Hancock St Ste 132, Portland, OR 97220-3873 | 2017-05-18 |
| 1760914493 | Changing Perceptions | Peer Specialist | 1720 Nw Lovejoy St # 329, Portland, OR 97209-2346 | 2017-03-31 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.