Sharon Kim Black, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071.009658 Issued in IL

Practice address

715 Lake St
Suite 706
Oak Park, IL 60301-1422

Phone

(773) 991-6375

NPI assigned

Jan 22, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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 Psychologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Blackbird Behavioral Health PCGroup PAC ID 4284998212, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Blackbird Behavioral Health, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oak Park, IL
  • NPI 1245748722
  Medicare reassignment Care Compare group NPD Authorized official
• Wholehealth Therapy Partners, Inc

  • Professional Counselor
  • Oak Park, IL
  • NPI 1457704603
  NPD

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1407094915",
    "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": "773-991-6375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 LAKE ST",
            "address_2": "SUITE 706",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011422",
            "telephone_number": "773-991-6375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "SHARON",
        "middle_name": "KIM",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-22",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.004472",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071.009658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Biomedical Concepts
• Tina Birnbaum, LCPC
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• David Bishop, L.C.S.W.
• BKD Personal Assistance Services LLC
• Blackbird Behavioral Health, PC
• Kenneth Morris Blair, M.D.
• Kenneth J Blake
• Luisa Blanco
• Johnathan Trent Blankenship

• Psychologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.