NPIMap

Organization Active NPI

Blackbird Behavioral Health, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oak Park, IL
National Provider Identifier
1245748722
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BLACKBIRD BEHAVIORAL HEALTH, PC
Practice address
715 Lake St Ste 410
Oak Park, IL 60301-1413
Phone
(708) 209-8987
NPI assigned
Jan 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Authorized official

Name
Sharon K Black, PSY.D.NPI 1407094915
Title
Director
Phone
(708) 209-8987

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

715 Lake St Ste 410
Oak Park, IL 60301-1413

Mailing address

633 Carpenter Ave
Oak Park, IL 60304-1104
Phone (708) 209-8987

Other names 1

  • BlackBird Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180427001868 IL Part B Supplier - Clinic/Group Practice 4284998212 Receives reassigned benefits from 3 practitioners
Practice locations: Oak Park, IL

National Provider Directory

National Provider Directory

Locations

715 Lake St
Ste 410
Oak Park, IL 60301
Phone (708) 209-8987

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1245748722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 CARPENTER AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041104",
            "telephone_number": "708-209-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 LAKE ST STE 410",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011413",
            "telephone_number": "708-209-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKBIRD BEHAVIORAL HEALTH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-209-8987",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BlackBird Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BlackBird Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.