Blake Alexander Medley

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4617 Issued in TN

Practice address

204 Shaver Dr
Talbott, TN 37877-8552

Phone

(423) 581-7040

Fax

(423) 581-9563

NPI assigned

Jun 25, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary Care Associates, PCGroup PAC ID 9931179041, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/4693/brand/6/csg/1/fhir/r4

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

• Primary Care Associates, PC

  • Pediatrics Physician
  • Talbott, TN
  • NPI 1306853965
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1043880834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SHAVER DR",
            "city": "TALBOTT",
            "state": "TN",
            "postal_code": "378778552",
            "telephone_number": "423-581-7040",
            "fax_number": "423-581-9563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SHAVER DR",
            "city": "TALBOTT",
            "state": "TN",
            "postal_code": "378778552",
            "telephone_number": "423-581-7040",
            "fax_number": "423-581-9563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLEY",
        "first_name": "BLAKE",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Jolene McBee
• Daniel Fox McCleary, MS
• Cinandra Beth McCleery, LCSW
• Michelle McCluskey, F.N.P.
• Christina Marie McCrudden, BSW
• Robin Reece Michaels, MEDICAL DOCTOR
• Carolyn Dorthea Minton, CNA
• Paula Mae Montes, FNP
• Amanda M Monville
• Tania Ivet Morales Ramos

• Physician Assistant in Talbott, TN
• Providers in Talbott, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; 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.