Holly Russell, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036120579 Issued in IL

Practice address

18210 La Grange Rd
Suite 205
Tinley Park, IL 60487-7722

Phone

(708) 478-7800

Fax

(708) 478-7870

NPI assigned

Jun 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: hrussell190933@direct.luriechildrens.org

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.

• Ann & Robert H. Lurie Children'S Hospital of Chicago

  • Children's Hospital
  • Chicago, IL
  • NPI 1235234535
  NPD
• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  NPD (past)
• Hahn Pediatric Group LLC

  • Pediatrics Physician
  • Tinley Park, IL
  • NPI 1003865643
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1174727267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18210 LA GRANGE RD STE 205",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604877725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18210 LA GRANGE RD",
            "address_2": "SUITE 205",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604877722",
            "telephone_number": "708-478-7800",
            "fax_number": "708-478-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "HOLLY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2005017735",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036120579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036120579",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hrussell190933@direct.luriechildrens.org",
            "affiliation": "N",
            "address_1": "18210 La Grange Rd",
            "address_2": "Suite 205",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "cc_hahn_pediatrics_nurse_pool100994@direct.luriechildrens.org",
            "affiliation": "N",
            "address_1": "18210 La Grange Rd",
            "address_2": "Suite 205",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Phillip Brent Rossberg, ATC, LAT
• Sharon Rowe
• Stephen G. Ruby, M.D.
• Tautvydas Rudzinskas, RBT
• Rush-Select Holdings, LLC.
• Timothy J. Russell, D.O.
• RXM Pharmacy Inc
• Rxnight LLC
• Breanna Ryan, OTR/L
• Thomas Joseph Ryan Jr., D.D.S.

• Pediatrics Physician in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.