Roger Alan Blake, M.D.
Individual provider Active NPI Surgical Critical Care Physician · Cleveland, MS
NPI 1023049335 · NPPES record last updated Mar 4, 2024
Key facts
- NPI
- 1023049335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Critical Care Physician 2086S0102X
- License
- MC-2670 (ID)
- Practice address
- 907 E Sunflower Rd
101
Cleveland, MS 38732-2830 - Phone
- (662) 846-8880
- Fax
- (662) 846-8886
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 34
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- University of Miami, LM Miller School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Medical Foundation Inc
Jefferson Hospital Association, Inc
Carle Health Care Incorporated
Practice addresses (Care Compare)
1314 19TH Ave
Meridian, MS 39301-4116
Phone (601) 484-6700
1601 W 40TH Ave
Suite 301
Pine Bluff, AR 71603-6346
Phone (870) 541-4285
2401 16TH St
Meridian, MS 39301-3950
Phone (601) 482-4181
611 W Park St
Urbana, IL 61801-2500
611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753
Hospital & facility affiliations
- Jefferson Regional Medical Center
- Carle Foundation Hospital
- Ochsner Rush Hospital
- Chicot Memorial Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 11 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 32 |
| Removal of tissue | 20 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in MS, TN, OK, IL, AR, LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050824000718 | MS | Practitioner - General Surgery | 8022049501 | Reassigns benefits to 5 organizations |
| I20221122001324 | TN | Practitioner - Anesthesiology | 8022049501 | |
| I20231103003208 | OK | Practitioner - General Surgery | 8022049501 | Reassigns benefits to 1 organization |
| I20240801001698 | IL | Practitioner - General Surgery | 8022049501 | Reassigns benefits to 1 organization |
| I20241112000962 | AR | Practitioner - Critical Care (Intensivists) | 8022049501 | Reassigns benefits to 1 organization |
| I20260610000694 | LA | Practitioner - General Surgery |
8022049501 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16881 | MS | MD | Specialist |
| MC-2670 | ID | MD | Surgical Critical Care Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Medical Foundation, Inc. | Current |
Accepting new patients | |
| Vicksburg Healthcare LLC | Current |
Accepting new patients | |
| Jefferson Hospital Association, Inc | Current |
Accepting new patients | |
| South Sunflower County Hospital | Current | Accepting new patients | |
| North Sunflower Medical Center | Current |
Accepting new patients | |
| South Sunflower County Hospital | Current | Accepting new patients | |
| Vicksburg Healthcare LLC | Current |
Accepting new patients | |
| Jefferson Hospital Association, Inc | Current |
Accepting new patients | |
| Warren Clinic Inc | Current |
Accepting new patients | |
| Medical Foundation, Inc. | Current |
Accepting new patients | |
| North Sunflower Medical Center | Current | Accepting new patients | |
| Greenwood Leflore Hospital | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Carle Health Care Incorporated | Current |
Accepting new patients | |
| North Sunflower Medical Center | Current | Accepting new patients | |
| North Sunflower Medical Center | Current |
Accepting new patients | |
| Jefferson Hospital Association, Inc | Current | Accepting new patients | |
| South Sunflower County Hospital | Current |
Accepting new patients | |
| South Sunflower County Hospital | Current |
Accepting new patients | |
| PHC-Cleveland LLC | Past | Accepting new patients | |
| University Surgery Associates, PLLC | Past | Accepting new patients | |
| Saint Alphonsus Specialty Services Inc | Past | Accepting new patients |
Locations
1609 W 40th Ave
Ste 403
Pine Bluff, AR 71603
Phone (870) 534-4188
1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100
1601 W 40th Ave
Ste 301
Pine Bluff, AR 71603
Phone (870) 541-4285
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
611 W Park St
Urbana, IL 61801
Phone (217) 383-6941
110 E Baker St
Indianola, MS 38751
Phone (662) 887-5155
110 E Baker St
#A
Indianola, MS 38751
Phone (662) 887-7081
2401 16th St
Meridian, MS 39301
Phone (601) 482-4181
840 N Oak Ave
Ruleville, MS 38771
Phone (601) 756-2711
202 S Ruby Ave
Ruleville, MS 38771
Phone (662) 756-2500
2100 Highway 61 N
Vicksburg, MS 39183
Phone (601) 883-5001
101 Rockefeller Dr
Ste 201
Muskogee, OK 74401
Phone (918) 682-4580
6600 S Yale Ave
Ste 1200
Tulsa, OK 74136
Phone (918) 488-6045
6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125
Interoperability endpoints
- blake_roger_alan_c_md@yourcarecommunity.org
- rogerblake@ifmg.allscriptsdirect.net
- https://fhir-usa.unify.chbase.com/org/sout-12412834
- rblake3206314@direct.trinity-health.org
- roger.blake@scs-direct.glh.org
- rogerblake@nsfmc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 16881 | MS | |
| Surgical Critical Care Physician | 2086S0102X | MC-2670 | ID | Yes |
Addresses
Primary practice location
907 E Sunflower Rd
101
Cleveland, MS 38732-2830
Mailing address
907 E Sunflower Rd
101
Cleveland, MS 38732-2830
Phone (662) 846-8880
Other practice location 1
999 N Curtis Rd Ste 415
Boise, ID 83706-1334
Phone (208) 302-2600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00122620 | Medicaid | MS | |
| 7887026 | Other | AETNA |
Other providers in Cleveland, MS
- Bethany Medical Clinic, LLC
- Tracy Marie Blackstock
- Don Blackwood
- Mark Edward Blackwood
- Blake Surgical Association PLLC
- Bolivar County Caa
- Bolivar County Council on Aging, Inc.
- Bolivar Emergency Group LLC
- Bolivar ENT, Inc
- Bolivar Pathology Services
All providers in Cleveland, MS · Surgical Critical Care Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.