Active NPI
Ann Carol Russell, LCSW
- Social Worker
- Champaign, IL
National Provider Identifier
1689845620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 819 Bloomington Rd
Champaign, IL 61820-2101 - Phone
- (217) 356-1558
- Fax
- (217) 366-0160
- NPI assigned
- Mar 18, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | IL | Primary |
Addresses
Primary practice location
819 Bloomington Rd
Champaign, IL 61820-2101
Mailing address
2905 North Main Street
Decatur, IL 62526
Phone (217) 877-9117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149008848 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205798400000",
"number": "1689845620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2905 NORTH MAIN STREET",
"city": "DECATUR",
"state": "IL",
"postal_code": "62526",
"telephone_number": "217-877-9117",
"fax_number": "217-877-3077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "819 BLOOMINGTON RD",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618202101",
"telephone_number": "217-356-1558",
"fax_number": "217-366-0160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ANN",
"middle_name": "CAROL",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-18",
"last_updated": "2008-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.