Derek James Bock, D.M.D., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021002219 Issued in IL

Practice address

840 S Waukegan Rd
Suite 107
Lake Forest, IL 60045-2608

Phone

(847) 615-5437

Fax

(847) 615-2955

NPI assigned

Jun 12, 2008

Last updated

Jan 29, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 4, 2016 through Jan 4, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Forest Orthodontics and Pediatric Dentistry

  • Pediatric Dentistry
  • Lake Forest, IL
  • NPI 1548408438

  Orthodontics and Dentofacial Orthopedics

  NPD (past)

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233187200000",
    "number": "1356501365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S WAUKEGAN RD",
            "address_2": "SUITE 107",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452608",
            "telephone_number": "847-615-5437",
            "fax_number": "847-615-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 S WAUKEGAN RD",
            "address_2": "SUITE 107",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452608",
            "telephone_number": "847-615-5437",
            "fax_number": "847-615-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCK",
        "first_name": "DEREK",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2009-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021002219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Ann Blendonohy, M.A./C.C.C.
• Mark Blitstein, M.D.
• Leslie Jay Block, MD
• Richard Allan Block, MD
• Anokhi Dalia Bock, D.M.D , M.S.D.
• Body Fixx
• Diane Boquist
• Bormes Urology, S.C.
• Karen Cristine Born, P.T.
• Cynthia Marie Borosh, RN

• Orthodontics and Dentofacial Orthopedics Dentistry in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2009; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.