BLAKE MICHAEL BODENDORFER (NPI# 1083000905) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083000905 |
| Entity Type | Individual |
| Full Name | BLAKE MICHAEL BODENDORFER |
| Credential | M.D. |
| Practice Address |
1611 W Harrison St Ste 400 Chicago IL 60612-4861 |
| Practice Telephone | 3124322351 |
| Practice Fax Number | 7084095179 |
| Mailing Telephone | 3124322351 |
| Mailing Fax Number | 7084095179 |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2020-06-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
036152051 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
1611 W HARRISON ST STE 400 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-4861 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770557811 | Brian Forsythe | Orthopaedic Surgery | 1611 W Harrison St Ste 400, Chicago, IL 60612 | 2006-02-15 |
| 1861022493 | Isabelle Baneux | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2020-01-23 |
| 1700429040 | William Sideras | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2019-10-18 |
| 1821643123 | Kaileen Elizabeth Healy | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2019-08-05 |
| 1124672498 | Yong Li | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2019-07-25 |
| 1326609017 | Hailey Christa Merk | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2019-06-24 |
| 1770045049 | Alissa Marie Winner | Nurse Practitioner | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2019-04-04 |
| 1790245371 | Max Monahan Levine | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2019-03-21 |
| 1780167213 | Samantha Fried | Registered Nurse | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2018-09-11 |
| 1184119471 | Joseph Bradley Samuels | Physician Assistant | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2018-06-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1568080174 | Nastaran Ordoyo Haghani Rad | Student in an Organized Health Care Education/Training Program | 1950 W. Polk Street, Room 6203, Chicago, IL 60612 | 2020-07-09 |
| 1669090403 | Marianne Gagnon-konamna | Student in an Organized Health Care Education/Training Program | 1950 West Polk Street, Chicago, IL 60612 | 2020-07-08 |
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1124643028 | Ashley Swan | Dentist | 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 | 2020-06-16 |
| 1831711381 | Baillie Anne Bronner | Obstetrics & Gynecology | 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 | 2020-05-07 |
| 1154942449 | Keisha Davell Cole | Case Manager/Care Coordinator | 612 S Western Ave Unit 1, Chicago, IL 60612 | 2020-04-28 |
| 1275153777 | Isac Lim | Student in an Organized Health Care Education/Training Program | 1234 S. Wells, Chicago, IL 60612 | 2020-04-24 |
| 1578183414 | Zachary Belden | Student in an Organized Health Care Education/Training Program | Uic Psychiatry Residency 912 S. Wood St., Rm 130b Npi-s (mc 913), Chicago, IL 60612 | 2020-04-21 |
| 1548880560 | Christina Nunez | Student in an Organized Health Care Education/Training Program | 801 S. Paulina Street, M/c 850, Chicago, IL 60612 | 2020-04-20 |
| Find all providers in zip 60612 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063048395 | Dr Ouilife LLC | Orthopaedic Surgery | 640 S Federal St Apt 410, Chicago, IL 60605-1800 | 2020-03-18 |
| 1568851251 | Benjamin Scott Kester | Orthopaedic Surgery | 1725 W Harrison St Ste Rush, Chicago, IL 60612-3841 | 2015-01-18 |
| 1568419463 | Mark K. Bowen | Orthopaedic Surgery | 680 N Lake Shore Dr Ste 924, Chicago, IL 60611 | 2006-05-27 |
| 1225677404 | Mary Kathleen Walsh | Orthopaedic Surgery | 1611 W Harrison St, Chicago, IL 60612-4861 | 2020-01-05 |
| 1902367642 | Sebastian Ko | Orthopaedic Surgery | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2019-03-26 |
| 1073080909 | Kierra La Shawn Bruno-rodgers | Orthopaedic Surgery | 712 N Dearborn St, Chicago, IL 60654-3846 | 2018-10-29 |
| 1124505508 | Robert Morris University Illinois | Orthopaedic Surgery | 401 S State St, Chicago, IL 60605-1229 | 2018-07-27 |
| 1992220404 | Chicago Sports Medicine Institute | Orthopaedic Surgery | 875 N Dearborn St, Chicago, IL 60610-7377 | 2017-08-04 |
| 1417330242 | Nicholas Anthony Trasolini | Orthopaedic Surgery | 1611 W Harrison St Ste 400, Chicago, IL 60612-4861 | 2015-06-29 |
| 1679960843 | John Lloyd Fritch | Orthopaedic Surgery | 5841 S Maryland Ave # Mc3079, Chicago, IL 60637-1443 | 2015-04-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.