Mirelle Davis Bloch, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010127 Issued in IL

Practice address

4305 N Lincoln Ave Ste a
Chicago, IL 60618-1807

Phone

(872) 226-2313

NPI assigned

Oct 10, 2019

Last updated

Oct 10, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

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

• Mirelle D. Bloch, Psy.D., LLC

  • Clinical Psychologist
  • Evanston, IL
  • NPI 1700644655
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1881236917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 WESLEY AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021160",
            "telephone_number": "872-226-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 N LINCOLN AVE STE A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181807",
            "telephone_number": "872-226-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOCH",
        "first_name": "MIRELLE",
        "middle_name": "DAVIS",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Matthew Blitzstein, M.D.
• Elana Blivaiss, APN
• Howard L Blivaiss, DDS
• John Nicholas Blizzard, MD
• Samuel Blizzard
• Naomi Bloch
• Candice Block
• Evelyn Sue Block
• Hanna Block, PA-C
• Joel Block, M.D.

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.