NPIMap

Individual provider Active NPI

Jessica Ann Banet Blake, FNP-C

  • Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1033394226
Registry record updated Apr 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3005563 Issued in KY
Practice address
200 Abraham Flexner Way
Louisville, KY 40202-1886
Phone
(502) 367-3360
Fax
(502) 367-3365
NPI assigned
Jan 7, 2008
Last updated
Apr 10, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3005563 KY Primary
Family Nurse Practitioner 363LF0000X 71002575A IN
Family Nurse Practitioner 363LF0000X 3005563 KY

Addresses

Primary practice location

200 Abraham Flexner Way
Louisville, KY 40202-1886

Mailing address

100 E Liberty St Ste 800
Louisville, KY 40202-1428
Phone (502) 587-4391

Other identifiers 1

IdentifierTypeStateIssuer
7100115460MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080623000544 KY Practitioner - Nurse Practitioner 0345319539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Abraham Flexner Way
Louisville, KY 40202-1886
Phone (502) 587-4401

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3005563KYMDNurse Practitioner
71002575AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. Nurse Practitioner CurrentSince May 26, 2020 Accepting new patients
Rehabilitation Associates, PSC Past Accepting new patients
University of Louisville Physicians Inc. Past Accepting new patients

Locations

1850 Bluegrass Ave
Louisville, KY 40215
Phone (502) 361-6617

200 Abraham Flexner Way
Louisville, KY 40202
Phone (502) 569-7983

220 Abraham Flexner Way
Ste 500
Louisville, KY 40202
Phone (502) 572-7577

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Organizations & group practices 3

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.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523318400000",
    "number": "1033394226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST STE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021428",
            "telephone_number": "502-587-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ABRAHAM FLEXNER WAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021886",
            "telephone_number": "502-367-3360",
            "fax_number": "502-367-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JESSICA",
        "middle_name": "ANN BANET",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-07",
        "last_updated": "2018-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3005563",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002575A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3005563",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100115460",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.