GEORGEANN L IACONO RUSSELL (PH.D) – Clinical Psychologist, NPI 1164552154
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,600 CLINICAL PSYCHOLOGIST in IL
Provider Addresses for GEORGEANN L IACONO RUSSELL (PH.D)
7411 WEST LAKE STREET
BUILDING A, SUITE L120
RIVER FOREST, IL 603051876
Phone: (708) 488-1919
Fax: (708) 763-2120
Type: Location
1825 DE FOREST LN
HANOVER PARK, IL 601335905
Phone: (630) 837-8028
Fax: (708) 763-2120
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-02-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040218000111 | I | Clinical Psychologist | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60305)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| R H E U M A T O L O G Y | IL | |
| Nurse Practitioner | IL | |
| Internal Medicine | IL | |
| Diagnostic Radiology | IL | |
| Family Practice | IL | |
| Family Practice | IL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | IL | |
| Hematology/Oncology, Internal Medicine | IL | |
| Diagnostic Radiology | MD | |
| Diagnostic Radiology | ND |
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