Jeffrey A Blalack, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

25520 Issued in TN

Practice address

1265 Union Ave
Memphis, TN 38104-3415

Phone

(316) 685-6091

NPI assigned

Apr 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1033175161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6060 PRIMACY PKWY",
            "address_2": "SUITE 241",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195745",
            "telephone_number": "901-725-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 UNION AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043415",
            "telephone_number": "316-685-6091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALACK",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "25520",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "24263",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3084438",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Blake
• Lindsey Blake
• Parker Alden Blake, PA-C
• Taylor Renee Blakemore
• Eric D Blakney, MD
• Jermar Blanchard
• Penelope Bland
• Trina Londra Bland, M.S.,CCC-SLP
• Emmitt Matthew Blankenship, PA-C
• Mona Victoria Adams Blankenship, MD

• Anesthesiology Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Anesthesiology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.