Doreen Blake, M.D.
Individual provider Active NPI Internal Medicine Physician · Largo, MD
NPI 1043209331 · NPPES record last updated Jun 4, 2014
Key facts
- NPI
- 1043209331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- D39421 (MD)
- Practice address
- 1450 Mercantile LN
Suite 111
Largo, MD 20774-5376 - Phone
- (301) 925-7610
- NPI assigned
- Oct 19, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- George Washington University School of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Luminis Health Medical Group, LLC
Practice addresses (Care Compare)
1450 Mercantile LN
Suite 111
Largo, MD 20774-5382
Phone (301) 925-7610
Hospital & facility affiliations
- Amedisys Home Health Care
- Adoration Home Health Marlboro
- Luminis Health Anne Arundel Medical Center, Inc
- Medstar Washington Hospital Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- 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 |
|---|---|---|---|---|
| I20110523000015 | DC | Practitioner - Internal Medicine | 1456301951 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luminis Health Medical Group, LLC | Current |
Accepting new patients | |
| Luminis Health Medical Group, LLC | Internal Medicine | Current |
Accepting new patients |
| Luminis Health Medical Group, LLC | Current | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
4175 N Hanson Ct
Ste 201
Bowie, MD 20716
Phone (443) 481-1199
1450 Mercantile Ln
Ste 111
Uppr Marlboro, MD 20774
Phone (301) 925-7610
Interoperability endpoints
- dblake28602@direct.aahs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D39421 | MD | Yes |
Addresses
Primary practice location
1450 Mercantile LN
Suite 111
Largo, MD 20774-5376
Mailing address
P.O. Box 12622
Belfast, ME 04915-4017
Phone (443) 481-6580
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116600000 | Medicaid | MD | |
| P01298022 | Other | RR MEDICARE |
Other providers in Largo, MD
- Elizabeth Biegelsen
- Salim Bilal Edwards
- Ben Birkenfeld
- Elizabeth Biru
- Blake & Sloan PC
- Latetia Tierra Bland
- Christie Lee Bogle
- George Herbert Bone
- Lauren Bonner
- Connie Borden
All providers in Largo, MD · Internal Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2014. 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.