Individual provider Active NPI

Blake Delacroix

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1124714639
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
125.083981 Issued in IL
Practice address
820 S Wood St Ste 100
Chicago, IL 60612
Phone
(312) 996-2933
NPI assigned
Apr 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 125.083981 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

820 S Wood St Ste 100
Chicago, IL 60612

Mailing address

820 S Wood St Ste 100
Chicago, IL 60612-4325

Other practice location 1

1501 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 626-0436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
125.083981ILMDDiagnostic Radiology Physician

Interoperability endpoints

  • Direct secure messaging: bdelacroix170949@uihealth.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1124714639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 S WOOD ST STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S WOOD ST STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-996-2933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Kings Hwy",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711034228",
            "country_code": "US",
            "telephone_number": "318-626-0436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELACROIX",
        "first_name": "BLAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-17",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "125.083981",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.