Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Raquel K Russo, PA-C

Individual provider Physician Assistant · NPI 1013545607

Raquel K Russo, PA-C is a Physician Assistant in Chesterfield, Missouri. Graduated from Saint Louis University School of Medicine in 2021, 5 years ago. Practices with Bluetail Medical Group, LLC, a 3-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
5
Trained at
Saint Louis University School of Medicine
Licensed in
MO
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

13353 Olive Blvd
Chesterfield, MO 63017-3108
Phone: (636) 778-2900
Fax: (636) 778-2828
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2022005794 (MO)

Record details

NPI number1013545607
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 30, 2020
Last updated in NPPESNovember 17, 2025
Certification dateNovember 17, 2025
Mailing address13353 Olive Blvd, Chesterfield, MO 63017-3108

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 2021 (5 years in practice)
Group practice Bluetail Medical Group, Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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