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BLAKE A BULLOCK LCSW
NPI 1295505014
Social Worker - Clinical in Evanston, IL

Active since January 03, 2024PECOS Enrolled
708 CHURCH ST STE 223, EVANSTON, IL 60201(312) 620-0396 Get Directions Write a Review

NPPES record last updated: July 2, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 2, 2025, Jan 3, 2024 (2 updates tracked since 2024).

About Blake A Bullock Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAKE A BULLOCK LCSW (NPI 1295505014) is an individual clinical provider in Evanston, Illinois, licensed in Illinois (149.024395) and active in the NPI registry since January 2024. He is enrolled in Medicare PECOS, maintains a secondary practice location in Chicago, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1295505014
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameBLAKE A BULLOCKCredential: LCSW
Location Address708 CHURCH ST STE 223Evanston, IL 60201-3881
Mailing Address1649 W Pratt Blvd Apt 3bChicago, IL 60626-4127 · (309) 540-8401
Phone(312) 620-0396
Sole ProprietorYes
Medical School CMSOtherGraduated 2017
Enumeration DateJanuary 3, 2024
Last NPPES UpdateJuly 2, 20252 updates tracked since enumeration
NPPES CertifiedJuly 2, 2025
✔ NPI 1295505014 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in IL · 149.024395
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
708 CHURCH ST STE 223, Evanston, IL 60201
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Secondary Practice Location 1

Location 11649 W Pratt Blvd Apt 3BChicago, IL 60626-4127 · Phone (309) 540-8401

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Providence Health Plan, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blake A Bullock Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6204374424
PECOS Enrollment IDI20250402002180
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $60.08 – $183.39
Typical copayment $0.00 (range $15.02 – $45.84)
Most-billed visit code NA
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FELIX ACUNA OLIVOS LCSW
Social Worker (Clinical)
708 CHURCH ST STE 223
EVANSTON, IL 60201
Cook County (872) 267-0059
ELYSIAN MENTAL HEALTH
Psychologist (Clinical)
708 CHURCH ST STE 223
EVANSTON, IL 60201
Cook County (989) 326-5621
SIVAN SCHNEIDER LLC
Psychologist (Clinical)
708 CHURCH ST STE 223
EVANSTON, IL 60201
Cook County (312) 493-7769

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Bullock's NPI number?

The NPI number for Blake Bullock is 1295505014. It was assigned to this individual provider in the NPPES registry on January 3, 2024.

Where is Blake Bullock located?

Blake Bullock practices at 708 Church St Ste 223, Evanston, IL 60201. The listed phone number is (312) 620-0396.

What is Blake Bullock's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Blake Bullock enrolled in Medicare?

Yes. Blake Bullock is registered in the Medicare PECOS enrollment system.

What insurance does Blake Bullock accept?

Health plans from Blue Cross and Blue Shield of Texas, Providence Health Plan and UnitedHealthcare list Blake Bullock as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Blake Bullock was last updated on July 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.