Individual provider Active NPI

Ladonna Sakina Russell, FNP

  • Family Nurse Practitioner
  • Willowbrook, IL
National Provider Identifier
1215508296
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2020145890 Issued in IL
Practice address
40 75TH St
Willowbrook, IL 60527-2325
Phone
(630) 581-5372
NPI assigned
Jul 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2020145890 IL Primary

Addresses

Primary practice location

40 75TH St
Willowbrook, IL 60527-2325

Mailing address

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210927001716 IL Practitioner - Nurse Practitioner 7517364011 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

13448 Cicero Ave
Crestwood, IL 60418-1430
Phone (708) 682-3384

4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000

4800 W 129TH St
Alsip, IL 60803-3016
Phone (708) 377-2169

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2020145890ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc CurrentSince Aug 20, 2021 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Aug 20, 2021 Accepting new patients
Physicians Immediate Care North Chicago LLC CurrentSince Aug 4, 2024 Accepting new patients

Locations

800 W Fulton Market
Fl 12
Chicago, IL 60607

5228 N Northwest Hwy
Chicago, IL 60630
Phone (773) 770-4707

4211 N Cicero Ave
Chicago, IL 60641
Phone (773) 794-1000

13448 Cicero Ave
Crestwood, IL 60418
Phone (708) 682-3384

4460 N Harlem Ave
Norridge, IL 60706
Phone (708) 402-9140

123 S Northwest Hwy
Park Ridge, IL 60068
Phone (224) 379-9632

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1215508296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325",
            "telephone_number": "630-581-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 75TH ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272325",
            "telephone_number": "630-581-5372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "LADONNA",
        "middle_name": "SAKINA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-11-15",
        "certification_date": "2021-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "2020145890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

Verify at the official NPI Registry.