Blake McConnell, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD215853 Issued in OR

Practice address

2485 12TH St SE
Salem, OR 97302-2151

Phone

(503) 363-8047

Fax

(503) 363-6571

NPI assigned

Jul 2, 2019

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

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Utah School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• First Call Home Health Agency, LLC Home health agency, Salem, OR, CCN 387147
• Amedisys Home Health Care Home health agency, Salem, OR, CCN 387136
• Salem Health West Valley Hospital, Dallas, OR, CCN 381308
• Salem Hospital Hospital, Salem, OR, CCN 380051

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
• WA PPO C-SNP

Interoperability endpoints

• Direct secure messaging: bmcconnell89874@direct.salemhealth.org

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.

• Salem Health

  • General Acute Care Hospital
  • Salem, OR
  • NPI 1265431829

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Salem Health West Valley

  • Critical Access Hospital
  • Dallas, OR
  • NPI 1245237486
  Medicare reassignment NPD
• Salem Health

  • Durable Medical Equipment & Medical Supplies
  • Keizer, OR
  • NPI 1487434775
  NPD
• Salem Health

  • Family Medicine Physician
  • Woodburn, OR
  • NPI 1578112066
  NPD

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

• First Call Home Health Agency, LLC

  • Home Health Agency
  • Salem, OR
  • NPI 1740260801
  Care Compare affiliation
• Salem Health

  • General Acute Care Hospital
  • Salem, OR
  • NPI 1265431829
  Care Compare affiliation
• Salem Health West Valley

  • Critical Access Hospital
  • Dallas, OR
  • NPI 1245237486
  Care Compare affiliation

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1063074789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13129",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973091129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2485 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022151",
            "telephone_number": "503-363-8047",
            "fax_number": "503-363-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONNELL",
        "first_name": "BLAKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-02",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "12439658-1205",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD215853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lenore McClure, AA DEGREE
• Rana McCollam
• David Mark McCollough, DMD MS
• Kimberly Renee McCollum, PSYD
• Pamela Lynn McCollum, LCSW
• Amy McCormick
• Christina Marie McCormick, COTA/L
• Kelly R McCormick, MD
• Jordan D McCourry, LMT
• Jeffery Scott McCoy, PHARM. D

• Family Medicine Physician in Salem, OR
• Providers in Salem, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.