Physician Compare National (NPI:1457370223)

HEALTHCARE PROVIDER: JILL ANNETTE RUSSELL M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1457370223
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092723171
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060331000108
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUSSELL
	Individual professional last name
Provider First Name	JILL
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	7810 MCGINNIS FERRY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 108
	Group Practice or individual's line 2 address
City	SUWANEE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300241634
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110087
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GWINNETT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y