James G Russell, LCPC
Individual provider Active NPI Professional Counselor · Danville, IL
NPI 1699009498 · NPPES record last updated Sep 25, 2009
Key facts
- NPI
- 1699009498
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180.004885 (IL)
- Practice address
- 102 Robinson St
Danville, IL 61832-8515 - Phone
- (217) 443-1772
- Fax
- (217) 443-1701
- NPI assigned
- Sep 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1996
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3545 N Vermilion St
Danville, IL 61832-1100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260116000890 | IL | Practitioner - Mental Health Counselor | 2860979226 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.004885 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Two Roads Wellness Clinic, LLC | Current |
Accepting new patients | |
| Two Roads Wellness Clinic, LLC | Current |
Accepting new patients |
Locations
3545 N Vermilion St
Danville, IL 61832
Phone (217) 442-8611
Interoperability endpoints
- james.russell.1@30412.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.004885 | IL | Yes |
Addresses
Primary practice location
102 Robinson St
Danville, IL 61832-8515
Mailing address
102 Robinson St
Danville, IL 61832-8515
Phone (217) 443-1772
Other providers in Danville, IL
- Jarron Rounsaville
- Devon L Rouse
- Carol J Rowe
- Roy Heart Clinic, LLC
- Linda Rudy
- Katelyn Ann Russell
- Sabeeha Haque Ali MD LLC
- Raja Irfan Sadiq
- Kulasekhar Sampath
- Rebecca Sanchez
All providers in Danville, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.