Roger Alan Blake, M.D.

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

MC-2670 Issued in 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

Last updated

Mar 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS, TN, OK, IL, AR, LA6 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 6

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 IncGroup PAC ID 9234043712, 211 clinicians

Jefferson Hospital Association, IncGroup PAC ID 8123927431, 80 clinicians

Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071
• Carle Foundation Hospital Hospital, Urbana, IL, CCN 140091
• Ochsner Rush Hospital Hospital, Meridian, MS, CCN 250069
• Chicot Memorial Medical Center Hospital, Lake Village, AR, CCN 041328

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: blake_roger_alan_c_md@yourcarecommunity.org
• FHIR API: https://fhir-usa.unify.chbase.com/org/sout-12412834
• Direct secure messaging: rblake3206314@direct.trinity-health.org
• Direct secure messaging: roger.blake@scs-direct.glh.org
• Direct secure messaging: rogerblake@ifmg.allscriptsdirect.net
• Direct secure messaging: rogerblake@nsfmc.allscriptsdirect.net

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

• Medical Foundation, Inc.

  • Family Medicine Physician
  • Meridian, MS
  • NPI 1609820539
  Medicare reassignment Care Compare group NPD
• Carle Health Medical Group

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment Care Compare group NPD
• Jefferson Hospital Association, Inc

  • Pulmonary Disease Physician
  • Pine Bluff, AR
  • NPI 1932157674
  Medicare reassignment Care Compare group NPD
• Greenwood Leflore Hospital

  dba Lucas Surgical Group

  • Surgery Physician
  • Greenwood, MS
  • NPI 1508145855
  Medicare reassignment NPD
• North Sunflower Medical Center

  dba Cleveland Medical Clinic

  • Family Medicine Physician
  • Cleveland, MS
  • NPI 1891705133
  Medicare reassignment NPD
• South Sunflower County Hospital

  • General Acute Care Hospital
  • Indianola, MS
  • NPI 1184679292
  Medicare reassignment NPD
• Vicksburg Healthcare LLC

  dba River Region Health System

  • Anesthesiology Physician
  • Vicksburg, MS
  • NPI 1629084058
  Medicare reassignment NPD
• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment NPD
• Lafayette Health Ventures Inc

  dba dba Family Health Plaza

  • Family Medicine Physician
  • Lafayette, LA
  • NPI 1417986092
  Medicare reassignment
• Blake Surgical Association PLLC

  • Surgical Critical Care Physician
  • Cleveland, MS
  • NPI 1154521466
  Authorized official Same address or phone
• Medical Foundation, Inc.

  dba Ochsner Rush Medical Center Emergency Room Professional Services

  • Emergency Medicine Physician
  • Meridian, MS
  • NPI 1700917994
  NPD
• North Sunflower Medical Center

  dba NSMC Pro Fees

  • Hospitalist Physician
  • Ruleville, MS
  • NPI 1013128644
  NPD

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

• Rush Medical Foundation

  dba Ochsner Rush Medical Center

  • General Acute Care Hospital
  • Meridian, MS
  • NPI 1770543399
  Care Compare affiliation
• Carle Surgicenter

  • Ambulatory Surgical Clinic/Center
  • Danville, IL
  • NPI 1225194533

  Hospital

  Care Compare affiliation
• Chicot Memorial Medical Center

  • Rural Health Clinic/Center
  • Lake Village, AR
  • NPI 1003213281

  Hospital

  Care Compare affiliation
• Chicot Memorial Medical Center

  • Clinic/Center
  • Lake Village, AR
  • NPI 1104238179

  Hospital

  Care Compare affiliation
• Chicot Memorial Medical Center

  • Critical Access Hospital
  • Lake Village, AR
  • NPI 1235453192
  Care Compare affiliation
• Chicot Memorial Medical Center

  • Clinic/Center
  • Lake Village, AR
  • NPI 1841602810

  Hospital

  Care Compare affiliation
• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Care Compare affiliation
• The Carle Foundation Hospital

  • General Acute Care Hospital
  • Urbana, IL
  • NPI 1013071653
  Care Compare affiliation

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1023049335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD",
            "address_2": "101",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322830",
            "telephone_number": "662-846-8880",
            "fax_number": "662-846-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD",
            "address_2": "101",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322830",
            "telephone_number": "662-846-8880",
            "fax_number": "662-846-8886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "999 N Curtis Rd Ste 415",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837061334",
            "country_code": "US",
            "telephone_number": "208-302-2600",
            "fax_number": "208-302-2625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ROGER",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "16881",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "ID",
            "license": "MC-2670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7887026",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122620",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Medical Clinic, LLC
• Tracy Marie Blackstock
• Don Blackwood, MD
• Mark Edward Blackwood, MD
• Blake Surgical Association PLLC
• Bolivar County Caa
• Bolivar County Council on Aging, Inc.
• Bolivar Emergency Group LLC
• Bolivar ENT, Inc
• Bolivar Pathology Services

• Surgical Critical Care Physician in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Surgical Critical Care Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.