Individual provider Active NPI

Matthew Russell, PHD

  • Clinical Psychologist
  • Skokie, IL
National Provider Identifier
1487203485
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071021089 Issued in IL
Practice address
9600 Gross Point Rd Ste 1200
Skokie, IL 60076-1214
Phone
(847) 909-5445
NPI assigned
Sep 11, 2019
Last updated
Apr 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 38283 TX
Clinical Psychologist 103TC0700X 071021089 IL Primary

Addresses

Primary practice location

9600 Gross Point Rd Ste 1200
Skokie, IL 60076-1214

Mailing address

2650 Ridge Ave Ste 1223
Evanston, IL 60201-1700

Other names 1

  • Matthew E.B. Russell Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200226000544 TX Practitioner - Clinical Psychologist 7517394877 Reassigns benefits to 1 organization
I20250909000283 IL Practitioner - Clinical Psychologist 7517394877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

9600 Gross Point Rd
Skokie, IL 60076-1214

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071021089ILMDClinical Psychologist
38283TXMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince Nov 19, 2019 Accepting new patients
Baylor College of Medicine CurrentSince Nov 19, 2019 Accepting new patients
Endeavor Health Medical Group CurrentSince Sep 1, 2025 Accepting new patients
Endeavor Health Medical Group Current Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

9600 Gross Point Rd
Ste 1200
Skokie, IL 60076
Phone (847) 503-4500

1502 Taub Loop
Houston, TX 77030
Phone (713) 873-4900

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

2 Greenway Plz
Ste 900
Houston, TX 77046
Phone (713) 798-1835

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1487203485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 GROSS POINT RD STE 1200",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761214",
            "telephone_number": "847-909-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MATTHEW",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "38283",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071021089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MATTHEW",
            "last_name": "RUSSELL",
            "middle_name": "E.B.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.