Bruce A Blacker, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036072584 Issued in IL

Practice address

2800 N Sheridan Rd
Suite 400
Chicago, IL 60657-6157

Phone

(773) 472-5803

Fax

(773) 472-7902

NPI assigned

Jul 20, 2005

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Apex Hospice and Palliative Care, Inc.

  • Community Based Hospice Care Agency
  • Westmont, IL
  • NPI 1356620090
  Medicare reassignment
• VHS Acquisition Subsidiary Number 3 Inc

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1922060938

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1982603924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N SHERIDAN RD",
            "address_2": "SUITE 400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576157",
            "telephone_number": "773-472-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N SHERIDAN RD",
            "address_2": "SUITE 400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576157",
            "telephone_number": "773-472-5803",
            "fax_number": "773-472-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKER",
        "first_name": "BRUCE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036072584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072584",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Michael Black, DMD
• Amy Meredith Blackburn, M.D.
• Anna M Blackburn, LCSW
• Joanna S Blackburn, MD
• Tracee A Blackburn, PA-C
• Lauren Seungduk Blacker
• Kevin Blackett, OD
• Amanda Jo Blackford, PHARMD
• Robyn Michelle Blackford, RDN
• Tiffany Blacklidge

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.