Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Blake Childress, PA-C

Individual provider Medical Physician Assistant · NPI 1750178190

Blake Childress, PA-C is a Physician Assistant in Chicago, Illinois. Qualified in 2024, 2 years ago. Practices with Physicians Immediate Care North Chicago LLC, a 261-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
2
Licensed in
IL
In the registry since
2025
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

6140 N Broadway St
Chicago, IL 60660-2538
Phone: (773) 564-9206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.011277 (IL)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1750178190
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedApril 21, 2025
Last updated in NPPESJune 12, 2025
Certification dateJune 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Physicians Immediate Care North Chicago Llc — 261 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations9 on file with Medicare

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