Blue Diamond Health Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLUE DIAMOND HEALTH CARE LLC

Practice address

2749 W North Ave
Chicago, IL 60647-5246

Phone

(773) 292-9660

NPI assigned

Aug 18, 2009

Last updated

Aug 18, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James L Vacracos

Title

Business Representative

Phone

(773) 292-9660

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1053543520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8606 DELAWARE ST",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463221776",
            "telephone_number": "219-765-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2749 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475246",
            "telephone_number": "773-292-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE DIAMOND HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "VACRACOS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS REPRESENTATIVE",
        "authorized_official_telephone_number": "773-292-9660"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085675",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.