Individual provider Active NPI

Cynthia Marie Russell, LCSW

  • Clinical Social Worker
  • South Elgin, IL
National Provider Identifier
1053489450
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.013675 Issued in IL
Practice address
460 Briargate Dr
Suite 700
South Elgin, IL 60177-2227
Phone
(847) 488-1999
Fax
(847) 488-9797
NPI assigned
Dec 1, 2006
Last updated
Dec 20, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.013675 IL Primary

Addresses

Primary practice location

460 Briargate Dr
Suite 700
South Elgin, IL 60177-2227

Mailing address

271 Elmwood LN Unit A2
Schaumburg, IL 60193-2032
Phone (773) 629-3082

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110513000554 IL Practitioner - Clinical Social Worker 9133305840 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Loyola University of Chicago, Stritch School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1041 W Stearns Rd
Bartlett, IL 60103-4509
Phone (630) 716-7500

1650 Moon Lake Blvd
Hoffman Estates, IL 60169-1010
Phone (847) 755-8090

1786 Moon Lake Blvd
Suite 104
Hoffman Estates, IL 60169-1016
Phone (847) 755-8090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.013675ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
VCC Counseling, Inc. Clinical CurrentSince Feb 15, 2011 Accepting new patients
Alexian Brothers Behavioral Health Hospital Clinical CurrentSince Jan 27, 2020 Accepting new patients

Locations

1240 Bamburg Ct
Ste 3A
Hanover Park, IL 60133
Phone (847) 372-6599

1650 Moon Lake Blvd
Hoffman Estates, IL 60169
Phone (800) 432-5005

460 Briargate Dr
Ste 700
South Elgin, IL 60177
Phone (847) 488-1999

Interoperability endpoints

  • Direct secure messaging: cynthia.russell.1@15182.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1053489450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 ELMWOOD LN UNIT A2",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601932032",
            "telephone_number": "773-629-3082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 BRIARGATE DR",
            "address_2": "SUITE 700",
            "city": "SOUTH ELGIN",
            "state": "IL",
            "postal_code": "601772227",
            "telephone_number": "847-488-1999",
            "fax_number": "847-488-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CYNTHIA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.013675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Elgin, IL

Sources for this page

Verify at the official NPI Registry.