Active NPI
Lynn Russell Lidell, D.C.
- Chiropractor
- Georgetown, TX
National Provider Identifier
1922008127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 7995
- Practice address
- 2913 Williams Dr
Ste 210
Georgetown, TX 78628-2739 - Phone
- (512) 639-8324
- Fax
- (512) 868-5977
- NPI assigned
- Jul 28, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 7995 | TX | Primary |
Addresses
Primary practice location
2913 Williams Dr
Ste 210
Georgetown, TX 78628-2739
Mailing address
PO Box 503
Hutto, TX 78634-0503
Phone (512) 639-8324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120223000764 | TX | Practitioner - Chiropractic | 8527226448 | Practice locations: Georgetown, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2913 Williams Dr
Suite 210
Georgetown, TX 78628-2739
Phone (512) 639-8324
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07995 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgetown Physical Therapy, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Georgetown, TX
- NPI 1083023782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477872000000",
"number": "1922008127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 503",
"city": "HUTTO",
"state": "TX",
"postal_code": "786340503",
"telephone_number": "512-639-8324",
"fax_number": "512-868-5977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2913 WILLIAMS DR",
"address_2": "STE 210",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786282739",
"telephone_number": "512-639-8324",
"fax_number": "512-868-5977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDELL",
"first_name": "LYNN",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-28",
"last_updated": "2016-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "7995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; 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.