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PETER DAMON RUSSOTTO DPM NPI 1770576829


NPI Information

NPI: 1770576829
Provider Name: PETER DAMON RUSSOTTO, DPM
Classification: Podiatrist - 213E00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1440 W WALNUT ST
#5
JACKSONVILLE, IL
ZIP 62650
Phone: (217) 243-3668
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Peter Damon Russotto, DPM is a podiatrist in Jacksonville, IL with 39 years of experience. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. Peter Damon Russotto, DPM NPI is 1770576829. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
Graduation Year:1985

The provider's business location address is:

1440 W WALNUT ST
#5
JACKSONVILLE, IL
ZIP 62650-143
Phone: (217) 243-3668

The NPI 1770576829 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Removal of tissue from wounds per session (HCPCS:97597)
  • Removal of 2 to 4 thickened skin growths (HCPCS:11056)
  • Removal of tissue from 6 or more finger or toe nails (HCPCS:11721)
  • Removal of single thickened skin growth (HCPCS:11055)
  • Removal of tissue from 1 to 5 finger or toe nails (HCPCS:11720)

The enumeration date for this NPI number is 8/24/2005 and was last updated on 7/8/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1213E00000XPodiatristILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1754460MEDICARE ID-TYPE UNSPECIFIED
2T38569MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.