Javon I Baker Sr., BEP CERTIFICATE

Primary specialty

DriverTaxonomy code 172A00000X

License

B260-4297-8034 Issued in IL

Practice address

222 W Forest Ave Apt 306
Round Lake, IL 60073-3541

Phone

(312) 914-7513

NPI assigned

Jan 13, 2022

Last updated

Jan 13, 2022By 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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1642032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1588315212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W FOREST AVE APT 306",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600733541",
            "telephone_number": "312-914-7513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W FOREST AVE APT 306",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600733541",
            "telephone_number": "312-914-7513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "JAVON",
        "middle_name": "I",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "BEP CERTIFICATE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "IL",
            "license": "B260-4297-8034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Driver in Round Lake, IL
• Providers in Round Lake, IL by specialty
• Driver in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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.