Wyvon Blackwell, MSN, APRN,FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209011447 Issued in IL

Practice address

31 W 155TH St
Harvey, IL 60426

Phone

(708) 596-5177

Fax

(708) 596-5518

NPI assigned

Oct 29, 2010

Sex

Female

Sole proprietor

Yes

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.

• Chicagoland Infectious Disease PC

  • Infectious Disease Physician
  • South Holland, IL
  • NPI 1780002352

  IL

  Medicare reassignment Care Compare group NPD
• Foundation for Outreach Services

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1316350242

  IL

  Medicare reassignment Care Compare group NPD
• Cermak Medical Group LLC

  • Family Medicine Physician
  • Cicero, IL
  • NPI 1518498393

  IL

  Medicare reassignment NPD
• TT Medical Group LLC

  • Family Medicine Physician
  • Crystal Lake, IL
  • NPI 1215528922
  NPD
• WB Global Care Consultants LLC

  • Family Nurse Practitioner
  • Oak Forest, IL
  • NPI 1295554111

  Family

  NPD
• Foundation for Emergency Services

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1467468280
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Bernard Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1811034291

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chicagoland Infectious Disease PC 38 clinicians

Foundation for Outreach Services 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Bernard Hospital Hospital, Chicago, IL, CCN 140103

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 5, 2019.

{
    "created_epoch": "1288310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1821398397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "60426",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "326 W 64th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606213114",
            "country_code": "US",
            "telephone_number": "773-962-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "326 W 64th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606213114",
            "country_code": "US",
            "telephone_number": "773-962-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "WYVON",
        "name_prefix": "Ms.",
        "credential": "MSN, APRN,FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-29",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "IN",
            "license": "28180607A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "F0214515",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "309007962",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209011447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209011447",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Better Future for Families Foundation
• Better Sister and Brother Growth Network
• Jay Bhatt, D.O. M.P.H.
• Lisa M. Bibb, M.D.
• Paul S Bierman, MD
• Lilyan Bland, RPH
• Evelyn Bollinger, RN
• Anthony Bothell, DPT
• BR Developmental Agency
• Brittani Bradley

• All providers in Harvey, IL
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.