Martin T Russo Jr. (NPI# 1508876236, PAC ID# 2264416718) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY PRACTICE.
| Nation Provider ID (NPI) | 1508876236 |
| PAC ID by PECOS | 2264416718 |
| Professional Enrollment ID | I20040614001359 |
| Full Name | Martin T Russo Jr. |
| Organization Legal Name | NOCH PHYSICIAN BILLING COMPANY LLC |
| Address |
1310 Wisconsin Ave Grand Haven MI 49417-2472 |
| Gender | M |
| Credential | DO |
| Medical School | CHICAGO COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 1978 |
| Primary Specialty | FAMILY PRACTICE |
| Group Practice PAC ID | 8527078583 |
| Number of Group Practice Members | 23 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230174 | NORTH OTTAWA COMMUNITY HEALTH SYSTEM |
| 230066 | MERCY HEALTH HACKLEY CAMPUS |
| Address | Phone | Organization |
|---|---|---|
| 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 | NOCH PHYSICIAN BILLING COMPANY LLC | |
| 1310 Wisconsin St, 103 Mhpp North Ottawa Family Medicine, Grand Haven, MI 49417-2472 | 6168462640 | MERCY PHYSICIAN NETWORK |
| 1445 Sheldon Rd, Grand Haven, MI 49417-2479 | NOCH PHYSICIAN BILLING COMPANY LLC |
| Organization Legal Name | NOCH PHYSICIAN BILLING COMPANY LLC |
| Physicians | 13 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Zachary A Horton | General Surgery | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Stuart J Vanderheide | Emergency Medicine | Noch Physician Billing Company LLC | 1445 Sheldon Rd, Grand Haven, MI 49417-2479 |
| Theresa J Pebbles | Physician Assistant | Noch Physician Billing Company LLC | 1445 Sheldon Rd, Grand Haven, MI 49417-2479 |
| Anda Bridge Scorza | Internal Medicine | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 100 North Ottawa Internal Medicine, Grand Haven, MI 49417-2472 |
| Caitlin Kelly Schmidt | Obstetrics/gynecology | Noch Physician Billing Company LLC | 1445 Sheldon Rd, Suite 301, Grand Haven, MI 49417-2479 |
| Rachel Mcdermott | Nurse Practitioner | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 100 North Ottawa Internal Medicine, Grand Haven, MI 49417-2472 |
| Anne M Zuidema | Nurse Practitioner | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Tania D Vandyke | Nurse Practitioner | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 301 North Ottawa Family Medicine, Grand Haven, MI 49417-2472 |
| Marilena Oravitan | Internal Medicine | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 100 North Ottawa Internal Medicine, Grand Haven, MI 49417-2472 |
| Stanley D Haegert | Family Practice | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Street Address |
1310 WISCONSIN AVE |
| City | GRAND HAVEN |
| State | MI |
| Zip | 49417-2472 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Zachary A Horton | General Surgery | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Anda Bridge Scorza | Internal Medicine | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 100 North Ottawa Internal Medicine, Grand Haven, MI 49417-2472 |
| Rachel Mcdermott | Nurse Practitioner | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 100 North Ottawa Internal Medicine, Grand Haven, MI 49417-2472 |
| Anne M Zuidema | Nurse Practitioner | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Tania D Vandyke | Nurse Practitioner | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 301 North Ottawa Family Medicine, Grand Haven, MI 49417-2472 |
| Marilena Oravitan | Internal Medicine | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 100 North Ottawa Internal Medicine, Grand Haven, MI 49417-2472 |
| Stanley D Haegert | Family Practice | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Raymond P Rabideau | Family Practice | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, 301 North Ottawa Family Medicine, Grand Haven, MI 49417-2472 |
| Larry A Poel | Family Practice | Noch Physician Billing Company LLC | 1310 Wisconsin Ave, Grand Haven, MI 49417-2472 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Derek Thomas Meyers | Optometry | Rx Optical Laboratories, Inc. | 1125 S Beacon, Grand Haven, MI 49417 |
| Barbara M Harris | Clinical Social Worker | 41 Washington St, Suite 320, Grand Haven, MI 49417 | |
| Lynn A Huizinga | Optometry | Rx Optical Laboratories, Inc. | 1125 S Beacon, Grand Haven, MI 49417 |
| Walker M Parmelee | Psychologist, Clinical | Parmelee and Associates Psychological Consultants, 321 Fulton, Grand Haven, MI 49417-1231 | |
| Mary F Peterson | Chiropractic | 635 Fulton Ave, Grand Haven, MI 49417-1237 | |
| Michael T Vollink | Optometry | Vollink Eyecare Pllc | 4 Washington Ave, Grand Haven, MI 49417-1353 |
| Terrance L Draeger | Optometry | Vollink Eyecare Pllc | 4 Washington Ave, Grand Haven, MI 49417-1353 |
| Terry Lanigan | Clinical Social Worker | 233 Washington St, Suite 212, Grand Haven, MI 49417-1374 | |
| Joseph Merrell Iii | Clinical Social Worker | 41 Washington Ave, Suite 368, Grand Haven, MI 49417-1378 | |
| Cynthia J Crawford | Clinical Social Worker | 41 Washington Ave, Suite 368, Grand Haven, MI 49417-1378 | |
| Find all physicians in zip 49417 | |||
| City | GRAND HAVEN |
| Zip Code | 49417 |
| Specialty | FAMILY PRACTICE |
| City + Specialty | GRAND HAVEN + FAMILY PRACTICE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.