Blake Hamilton Gilliam

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-153719 Issued in AL

Practice address

1230 Slaughter Rd Ste C
Madison, AL 35758-5901

Phone

(256) 325-0955

NPI assigned

Mar 3, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 17, 2022 through Nov 17, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: blake.gilliam@506989899546628.direct.elationemr.com

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1043845787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 SLAUGHTER RD STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357585901",
            "telephone_number": "256-325-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 SLAUGHTER RD STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357585901",
            "telephone_number": "256-325-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "BLAKE",
        "middle_name": "HAMILTON",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AL",
            "license": "1-153719",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-153719",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-153719",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry U. Gibson, LPC, NCC
• Matthew Gibson, D.M.D.
• McKenna Rhea Gibson, D.M.D.
• Mayson Deshea Giffel
• Hannah Gilbert, OTR
• Chad Jamison Gilliam, MMS, PA-C
• Heather Gilliam, CLD
• Howard L Gilliam, D.O., N.D.
• Stephanie Nichole Smith Gilliam, CRNA
• Todd Anthony Gilmore Jr., ATC

• Nurse Practitioner in Madison, AL
• Providers in Madison, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.