MARINA K RUSSO (NPI# 1174510978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174510978 |
| Entity Type | Individual |
| Full Name | MARINA K RUSSO |
| Credential | MD |
| Practice Address |
1118 Legacy Pointe Dr Springfield IL 62711 |
| Practice Telephone | 2177878870 |
| Practice Fax Number | 2177876158 |
| Mailing Telephone | 2177878870 |
| Mailing Fax Number | 2177876158 |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2015-08-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
036102799 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | CATERPILLAR | 6394P | 01 |
| IL | BLACK LUNG | 020057300 | 01 |
| IL | RR MEDICARE GRP | CD7143 | 01 |
| IL | BLUE CROSS BLUE SHIELD | 08421024 | 01 |
| IL | CLIA CERT | 14D0949277 | 01 |
| IL | 036102799 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198208 | Marina A Russo | Social Worker | 19 Cherry Hill Rd, New Paltz, NY 12561-2207 | 2019-11-15 |
| Street Address |
1118 LEGACY POINTE DR |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578057220 | Merissa Pryor | Social Worker | 4200 Conestoga Drive, Mbn 120, Springfield, IL 62711 | 2018-06-17 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1841682424 | Americare At Centennial Pointe Assisted Living LLC | Assisted Living Facility | 3440 Hedley Road, Springfield, IL 62711 | 2015-02-19 |
| 1306249248 | Schon Dental, LLC | Dentist | 2809 Mansion Road Suite D, Springfield, IL 62711 | 2014-10-07 |
| 1891105490 | John Weiss | Pharmacist | 4200 Conestoga Drive, Springfield, IL 62711 | 2014-05-05 |
| 1720350689 | Victor Harold Lary | Family Medicine | 3251 Spaulding Orchard Road, Springfield, IL 62711 | 2012-02-07 |
| 1902181795 | Amanda Rose Davis | Pharmacist | 2500 Koke Mill Rd, Springfield, IL 62711 | 2011-10-12 |
| 1316233703 | Karen Zerkle | Dentist | 2809 Mansion Rd, Suite D, Springfield, IL 62711 | 2011-06-23 |
| 1255520557 | Link Chiropractic LLC | Chiropractor | 7012 Kingsmill Ct, Springfield, IL 62711 | 2007-10-23 |
| 1669688230 | Victoria Lynn Driskill | Dentist | 4701 W. Wabash Ave, Springfield, IL 62711 | 2007-05-14 |
| Find all providers in zip 62711 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1710243621 | Michele A Gortakowski | Internal Medicine | 3300 Main St Fl 3, Springfield, MA 01107-1112 | 2012-04-04 |
| 1538319447 | Joy Debbie Sudler | Internal Medicine | 28 Cottage Ln, Springfield, NJ 07081-2303 | 2008-09-27 |
| 1295714657 | Catherine M Hegarty | Internal Medicine | 2150 Main Street, Springfield, MA 01104 | 2006-01-13 |
| 1124023726 | Linda R. Macgorman | Internal Medicine | 960 E Walnut Lawn, Suite 201, Springfield, MO 65807 | 2005-06-20 |
| 1871948414 | Prospect Health Access Network, Inc. | Internal Medicine | 190 W Sproul Rd, Suite 102, Springfield, PA 19064-2027 | 2016-05-02 |
| 1467894527 | Sanober Parveen | Internal Medicine | 751 N Rutledge St Ste 1700, Springfield, IL 62702-4968 | 2013-07-17 |
| 1811338841 | Mariam Murtaza Ali | Internal Medicine | 751 N Rutledge St Ste 1700, Springfield, IL 62702-4968 | 2013-07-05 |
| 1316382823 | Cecilia A Davis | Internal Medicine | 3300 Main Street, Springfield, MA 01107-1112 | 2013-05-10 |
| 1821337627 | New England Endocrine and Thyroid Center, PC | Internal Medicine | 299 Carew St, Suite 323, Springfield, MA 01104-2301 | 2013-02-14 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62711 |
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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.