Provider Demographics
NPI:1992704381
Name:BECKETT, JAMES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:BECKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2517
Mailing Address - Country:US
Mailing Address - Phone:708-341-6707
Mailing Address - Fax:708-298-5723
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:ST BERNARD HOSPITAL DEPT RADIOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:773-962-4030
Practice Address - Fax:773-962-4399
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087374207QA0401X
IL36-0873742085R0204X, 2085U0001X, 2085R0202X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087374Medicaid
IL630001349OtherRR MED
IL01621173OtherBC/BS
IL630001349OtherRR MED
E07422Medicare UPIN