Jacob Aaron Russell, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070029347 Issued in IL

Practice address

1104 W Main St
Benton, IL 62812-1565

Phone

(618) 439-3399

Fax

(618) 439-4801

NPI assigned

Aug 21, 2025

Last updated

Aug 28, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Orthopedic Associates SCGroup PAC ID 8921095514, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Southern Orthopedic Associates SC

  • Orthopaedic Surgery Physician
  • Herrin, IL
  • NPI 1396792412
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1755734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1356228142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 W MAIN ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121565",
            "telephone_number": "618-439-3399",
            "fax_number": "618-439-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 W MAIN ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121565",
            "telephone_number": "618-439-3399",
            "fax_number": "618-439-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JACOB",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-21",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070029347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gemilo Resaba, M.D.
• Richard Rethorst, MD
• Ben Rice
• RLH Anesthesia Service PC
• Lori Dyan Ruhnke, PMHNP
• Linda K Ryan, RN
• Saeed a. Khan
• Mikayla Sanders
• Jacqueline Schofield
• Annalee Schuette

• Physical Therapist in Benton, IL
• Providers in Benton, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.