Katelin Lee Ann Russell, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038.014099 Issued in IL

Practice address

18 Emerald Ter
Swansea, IL 62226-2321

Phone

(618) 234-6000

Fax

(618) 234-6009

NPI assigned

Jan 1, 2024

Last updated

Jan 1, 2024By the provider in NPPES

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 names 1

• Katelin Lee Ann Boyer Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantage Family Chiropractic LLCGroup PAC ID 3870590920, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Advantage Family Chiropractic LLC

  • Chiropractor
  • Belleville, IL
  • NPI 1629151675
  Medicare reassignment Care Compare group
• Wallace P Berkowitz MD LTD

  • Otolaryngology Physician
  • Saint Louis, MO
  • NPI 1952387516
  NPD (past)

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

{
    "created_epoch": "1704067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704067200000",
    "number": "1659140796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 EMERALD TER",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262321",
            "telephone_number": "618-234-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 EMERALD TER",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262321",
            "telephone_number": "618-234-6000",
            "fax_number": "618-234-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KATELIN",
        "middle_name": "LEE ANN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-01",
        "last_updated": "2024-01-01",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.014099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELIN",
            "last_name": "BOYER",
            "middle_name": "LEE ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kayla R Roulette, MA, LCPC
• Daniel M. Rovin, D.C.
• Gary L Rovin, D.C.
• Paula Jo Rush Shumpert, DT
• Gillian Joell Russell
• Nadiah Sabrah, MSW, LCSW, THERAPIST
• Sacrae LLC
• John Douglas Sadoff, M.D.
• Melody Santos, M.D.
• Dameckia Sattlefield

• Chiropractor in Swansea, IL
• Providers in Swansea, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; 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.