Blanca M Baldoceda, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036112358 Issued in IL

Practice address

3231 Euclid Ave FL 5
Berwyn, IL 60402-4603

Phone

(708) 783-2000

NPI assigned

Jun 8, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primecare Community Health, Inc.Group PAC ID 6204722077, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence Saints Mary and Elizabeth Medical Center Hospital, Chicago, IL, CCN 140180

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Primecare Community Health, Inc.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1558532739
  Medicare reassignment Care Compare group NPD
• PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Oak Park, IL
  • NPI 1871516799
  Medicare reassignment NPD
• PCC Community Wellness Center

  dba PCC Austin Dental & Specialty Care Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1134954506
  NPD
• Primecare Community Health Inc

  dba Elston

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1891541215
  NPD
• Primecare Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1225010911

  Family Medicine

  NPD
• Loyola University Medical Center

  dba Mulcahy Pharmacy

  • Community/Retail Pharmacy
  • Maywood, IL
  • NPI 1184789299
  NPD (past)
• Primecare Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1700230398
  NPD (past)

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

• Saint Mary of Nazareth Hospital - Chicago LLC

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1265270607
  Care Compare affiliation

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1871533703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 ELLINWOOD AVE",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164553",
            "telephone_number": "773-570-3337",
            "fax_number": "773-453-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 EUCLID AVE FL 5",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604024603",
            "telephone_number": "708-783-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1535 Ellinwood Ave",
            "address_purpose": "LOCATION",
            "city": "Des Plaines",
            "state": "IL",
            "postal_code": "600164553",
            "country_code": "US",
            "telephone_number": "773-570-3337",
            "fax_number": "773-453-4955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALDOCEDA",
        "first_name": "BLANCA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036112358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112358",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry L Bailey, MD
• Breanna Lynn Baker
• John U Baker, LCSW
• James Louis Bakos, D.P.M.
• Samir Balaney, D.D.S.
• Christopher D Bane, M.D.
• Wade Banks Jr.
• Rebecca M Baran, DPT
• Sara E Baranowski, MA CCC-SLP
• Barclays Web Crafters

• Family Medicine Physician in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.