Blake Wollam

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.0031396 Issued in OH

Practice address

7060 Wayside Dr
Mentor, OH 44060-6527

Phone

(440) 357-2770

NPI assigned

Aug 1, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180
• South Pointe Hospital Hospital, Warrensville Heights, OH, CCN 360144

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment Care Compare group NPD
• Cleveland Clinic Health System - East Region

  • General Acute Care Hospital
  • Warrensville Heights, OH
  • NPI 1235183542
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cleveland Clinic Health System - East Region

  • General Acute Care Hospital
  • Warrensville Heights, OH
  • NPI 1235183542
  Care Compare affiliation
• Cleveland Clinic Health System - East Region

  • General Acute Care Hospital
  • Mayfield HTS, OH
  • NPI 1902858152
  Care Compare affiliation
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1013643048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2157 LAKELAND AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441075715",
            "telephone_number": "740-457-6815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 WAYSIDE DR",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606527",
            "telephone_number": "440-357-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLAM",
        "first_name": "BLAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0031396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Marie Wolf, M.ED., LPC
• Renee A Wolf, RN
• Basil N. Wolfe Jr., AU.D.
• Susannah Amelia Wolfe, CDCA
• Lawrence H Wolkoff, MD
• Melissa Christine Wong
• Dorothy Woods
• Paola M Wooten, SWT, QMHS
• James Tony Workman Jr., LPCC
• Octavia Joy Workman

• Family Nurse Practitioner in Mentor, OH
• Providers in Mentor, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.