Victoria Blaylock, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018941 Issued in IL

Practice address

4835 N Kenmore Ave
Apt B
Chicago, IL 60640-3727

Phone

(773) 993-2770

NPI assigned

Dec 28, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mana Health Partners PAGroup PAC ID 3971952813, 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: victoriablaylock@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mana Health Partners PA

  • Internal Medicine Physician
  • Sarasota, FL
  • NPI 1437925047
  Medicare reassignment Care Compare group NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD
• Shine Medical Providers PC

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1538894050
  NPD (past)

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1033654181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 N KENMORE AVE",
            "address_2": "APT B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606403727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 N KENMORE AVE",
            "address_2": "APT B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606403727",
            "telephone_number": "773-993-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAYLOCK",
        "first_name": "VICTORIA",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Blauser, MS, PA-C
• Mara Blaustein
• Anna Ruth Blauw
• Cheri Blauwet, MD
• Andrea Blaylock, LCSW
• Gabrielle Blazek
• Rachel Blazek, PT
• Melisa Blazevic
• Mary Blazevich, PT
• Matthew Francis Blazo, PA-C

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.
• 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.

Verify at the official NPI Registry.