MEDICARE: JAMES EDWARD BECKETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	036-087374	IL
2	2085R0204X	Vascular & Interventional Radiology Physician	36-087374	IL
3	2085U0001X	Diagnostic Ultrasound Physician	36-087374	IL
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	2085R0202X	Diagnostic Radiology Physician	36-087374	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	630001349	OTHER	IL	RR MED
3	01621173	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1992704381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD BECKETT M.D.

Provider Business Mailing Address
First Line	:	2 CARRINGTON CT
Second Line	:
City	:	HAZEL CREST
State	:	IL
Zip	:	60429-2517
Country	:	US
Telephone Number	:	708-341-6707
Fax Number	:	708-298-5723

Provider Business Practice Location Address
First Line	:	326 W 64TH ST
Second Line	:	ST BERNARD HOSPITAL DEPT RADIOLOGY
City	:	CHICAGO
State	:	IL
Zip	:	60621-3114
Country	:	US
Telephone Number	:	773-962-4030
Fax Number	:	773-962-4399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	03/23/2018

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