Georgeann L Iacono Russell, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-004593 Issued in IL

Practice address

7411 West Lake Street
Building a, Suite L120
River Forest, IL 60305-1876

Phone

(708) 488-1919

Fax

(708) 763-2120

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Resilience Healthcare - Lakefront Medical Associates LLCGroup PAC ID 5991046468, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: georgeann.iacono.russell.1@18552.direct.athenahealth.com
• Direct secure messaging: georgeann.iacono.russell.1@13158.direct.athenahealth.com

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

• Resilience Healthcare - Lakefront Medical Associates, LLC

  • General Practice Physician
  • Chicago, IL
  • NPI 1205301926
  Medicare reassignment Care Compare group NPD
• West Suburban Hospital Medical Center

  • Skilled Nursing Facility
  • Oak Park, IL
  • NPI 1538206974
  NPD (past)
• West Suburban Medical Center

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1649499096
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299801600000",
    "number": "1164552154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 DE FOREST LN",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601335905",
            "telephone_number": "630-837-8028",
            "fax_number": "708-763-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7411 WEST LAKE STREET",
            "address_2": "BUILDING A, SUITE L120",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051876",
            "telephone_number": "708-488-1919",
            "fax_number": "708-763-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACONO RUSSELL",
        "first_name": "GEORGEANN",
        "middle_name": "L",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2011-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-004593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "21623162",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Mark Hommes, PA-C
• Estefania Huesca
• Carlissa Richards Hughes, PH.D.
• Shelby Hughes, FNP
• Faiqa Hussain, PHARMD
• John Ilic
• Integrative Chiropractic & Wellness, LLC
• Integrative Therapies, LTD.
• Internal Medicine Center of Oak Park and River Forest SC
• Ivan Ivanov, DO

• Clinical Psychologist in River Forest, IL
• Providers in River Forest, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.