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MR. WILLIE LARRY BLACKMON LCPC; CADC; MA
NPI 1477762052
Counselor - Professional in Hazel Crest, IL

Active since May 21, 2007PECOS EnrolledAccepts Medicare Assignment
17504 E CARRIAGEWAY DR STE B, HAZEL CREST, IL 60429(708) 799-0300(708) 799-0300 Get Directions Write a Review

NPPES record last updated: April 23, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mr. Willie Larry Blackmon Lcpc; Cadc; Ma NPPES

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

MR. WILLIE LARRY BLACKMON LCPC; CADC; MA (NPI 1477762052) is an individual professional provider in Hazel Crest, Illinois, licensed in Illinois (180.007189) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS and is a graduate of Other (2001).

NPPES Registry Identity

NPI1477762052
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameMR. WILLIE LARRY BLACKMONCredential: LCPC; CADC; MA
Location Address17504 E CARRIAGEWAY DR STE BHazel Crest, IL 60429-2089
Mailing Address5834 S Maplewood AveChicago, IL 60629-1124 · (773) 778-4835 · Fax (773) 778-4835
Phone(708) 799-0300
Fax(708) 799-0300
Sole ProprietorNo
Medical School CMSOtherGraduated 2001
Enumeration DateMay 21, 2007
Last NPPES UpdateApril 23, 2009
✔ NPI 1477762052 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 180.007189
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 5848 (IL)
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 178-002766 (IL)
17504 E CARRIAGEWAY DR STE B, Hazel Crest, IL 60429
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Willie Larry Blackmon Lcpc; Cadc; Ma is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1557899366
PECOS Enrollment IDI20250107003508
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.

Medicare Billing Reassignment

Medicare enrollment records show Willie Blackmon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Blackmon Counseling Services
15 mi
Community/Behavioral Health
5834 S MAPLEWOOD AVE
Chicago, IL 60629
  • Reassigned Medicare billing, Illinois enrollment
NPI 1154754547 (773) 778-4835

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 2

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

ROBINA RENEE WILLIAMS
Homemaker
17504 E CARRIAGEWAY DR STE B
HAZEL CREST, IL 60429
Cook County (708) 446-3221
CATHERINES VISION HEALTH SERVICES LLC
In Home Supportive Care
17504 E CARRIAGEWAY DR STE B
HAZEL CREST, IL 60429
Cook County (708) 308-7605

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 Willie Blackmon's NPI number?

The NPI number for Willie Blackmon is 1477762052. It was assigned to this individual provider in the NPPES registry on May 21, 2007.

Where is Willie Blackmon located?

Willie Blackmon practices at 17504 E Carriageway Dr Ste B, Hazel Crest, IL 60429. The listed phone number is (708) 799-0300.

What is Willie Blackmon's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Willie Blackmon enrolled in Medicare?

Yes. Willie Blackmon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Willie Blackmon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Willie Blackmon reassigns Medicare benefits to Blackmon Counseling Services (Chicago, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Willie Blackmon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Willie Blackmon was last updated on April 23, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years 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.