Individual provider Active NPI

Blair Kayla Dodson, MD

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1023646544
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
125.079679 Issued in IL
Practice address
251 E Huron St
Chicago, IL 60611-3055
Phone
(540) 538-6388
NPI assigned
Mar 30, 2020
Last updated
Jun 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Diagnostic Radiology Physician 2085R0202X 125.079679 IL Primary

Addresses

Primary practice location

251 E Huron St
Chicago, IL 60611-3055

Mailing address

676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone (540) 538-6388

Other practice location 1

825 Fairfax Ave Ste 563
Norfolk, VA 23507-1914
Phone (757) 446-5794

Other practice location 2

676 N Saint Clair St Ste 800
Chicago, IL 60611-2978
Phone (540) 538-6388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240228003891 IL Order and Referring Only - Diagnostic RadiologyPractitioner - Diagnostic Radiology 0547683500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.079679ILMDDiagnostic Radiology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1023646544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 800",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112978",
            "telephone_number": "540-538-6388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 E HURON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113055",
            "telephone_number": "540-538-6388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 Fairfax Ave Ste 563",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235071914",
            "country_code": "US",
            "telephone_number": "757-446-5794",
            "fax_number": "757-446-7921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "676 N Saint Clair St Ste 800",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112978",
            "country_code": "US",
            "telephone_number": "540-538-6388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DODSON",
        "first_name": "BLAIR",
        "middle_name": "KAYLA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "125.079679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.