Active NPI
Mary Russell, PH.D.
- Psychologist
- Urbana, IL
National Provider Identifier
1922472927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.007739
- Practice address
- 404 W Green St
Urbana, IL 61801-3267 - Phone
- (217) 621-9302
- NPI assigned
- Nov 15, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071.007739 | IL | Primary |
Addresses
Primary practice location
404 W Green St
Urbana, IL 61801-3267
Mailing address
404 W Green St
Urbana, IL 61801-3267
Phone (217) 621-9302
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 5, 2016 through Jul 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.007739 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447545600000",
"number": "1922472927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 W GREEN ST",
"city": "URBANA",
"state": "IL",
"postal_code": "618013267",
"telephone_number": "217-621-9302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 W GREEN ST",
"city": "URBANA",
"state": "IL",
"postal_code": "618013267",
"telephone_number": "217-621-9302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-15",
"last_updated": "2015-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.007739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.