1. Home
  2. Directory
  3. New York
  4. Nesconset
  5. Physician Assistant
  6. NPI Profile

MR. RUSSELL JOHN RIDULFO PA
NPI 1407697683
Physician Assistant in Nesconset, NY

Active since June 03, 2024PECOS EnrolledAccepts Medicare Assignment
12 MAPLE GLEN LN, NESCONSET, NY 11767(631) 942-0295 Get Directions Write a Review

NPPES record last updated: June 3, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mr. Russell John Ridulfo Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. RUSSELL JOHN RIDULFO PA (NPI 1407697683) is an individual physician assistant in Nesconset, New York and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS, is affiliated with St Charles Hospital, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1407697683
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. RUSSELL JOHN RIDULFOCredential: PA
Location Address12 MAPLE GLEN LNNesconset, NY 11767-1712
Mailing Address12 Maple Glen LnNesconset, NY 11767-1712 · (631) 942-0295
Phone(631) 942-0295
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateJune 3, 2024
NPPES CertifiedJune 3, 2024
✔ NPI 1407697683 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
12 MAPLE GLEN LN, Nesconset, NY 11767
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Russell John Ridulfo Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648705715
PECOS Enrollment IDI20241126002310
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Charles Hospital

Acute Care Hospitals · Port Jefferson, NY
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number330246
Location200 Belle Terre RoadPort Jefferson, NY 11777 · Suffolk County
Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11767 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Russell Ridulfo's NPI number?

The NPI number for Russell Ridulfo is 1407697683. It was assigned to this individual provider in the NPPES registry on June 3, 2024.

Where is Russell Ridulfo located?

Russell Ridulfo practices at 12 Maple Glen Ln, Nesconset, NY 11767. The listed phone number is (631) 942-0295.

What is Russell Ridulfo's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Russell Ridulfo enrolled in Medicare?

Yes. Russell Ridulfo is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Russell Ridulfo affiliated with any hospitals?

According to CMS data, Russell Ridulfo is affiliated with St Charles Hospital.

When was this NPI record last updated?

The NPPES record for Russell Ridulfo was last updated on June 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.