ANTONIETTA ANNA RUSSO (P.H.D.) – Psychologist, NPI 1831211895

ANTONIETTA ANNA RUSSO (P.H.D.) is a healthcare provider. based in Murray, Utah. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials P.H.D.. They hold a License No. 370566-2501 (UT). The NPI Number for ANTONIETTA ANNA RUSSO (P.H.D.) is 1831211895

Main info

Female
Sole Proprietor
29 Years Of Experience
Accepts Medicare Assignment
Name
ANTONIETTA ANNA RUSSO (P.H.D.)
NPI
1831211895
Phone
(801) 314-4736
Address
5801 FASHION BLVD
Enumeration Date
3 April 2007
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8013145000
Graduation Year
1997 (29 years ago)
PAC ID
5890682660
Group Practice PAC ID
1850209420
Professional Enrollment ID
I20040304000619
Address ID
UT841076165MU5770X250X301
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

238 CLINICAL PSYCHOLOGIST in UT

Provider Addresses for ANTONIETTA ANNA RUSSO (P.H.D.)

  • 5801 FASHION BLVD

    STE 190

    MURRAY, UT 841076159

    Phone: (801) 314-4736

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-03-04

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040304000619IClinical PsychologistUTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90837Psychotherapy, 1 hour8126$0
View full utilization report →

Insurance plans in this area (ZIP 84107)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1850209420View full group profile

Reviews

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Frequently asked questions

What is the standard ID for ANTONIETTA ANNA RUSSO (P.H.D.) in the U.S.?
In the U.S., ANTONIETTA ANNA RUSSO (P.H.D.) is identified by NPI 1831211895.
Quick check: is ANTONIETTA ANNA RUSSO (P.H.D.) active?
Public NPPES data shows ANTONIETTA ANNA RUSSO (P.H.D.) with an active NPI status right now.
Which specialty label fits ANTONIETTA ANNA RUSSO (P.H.D.)?
NPPES ties ANTONIETTA ANNA RUSSO (P.H.D.) to Psychologist in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to ANTONIETTA ANNA RUSSO (P.H.D.)?
ANTONIETTA ANNA RUSSO (P.H.D.) is associated with Murray, Utah in the same public data insurers reference.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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