Individual provider Active NPI

Blake Kent Windham, MD

  • Student in an Organized Health Care Education/Training Program
  • Ocean Springs, MS
National Provider Identifier
1093418402
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
202 Ashley PL
Ocean Springs, MS 39564-5338
Phone
(228) 219-1119
NPI assigned
Mar 24, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

202 Ashley PL
Ocean Springs, MS 39564-5338

Mailing address

202 Ashley PL
Ocean Springs, MS 39564-5338
Phone (228) 219-1119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20231113001845 FL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8123475175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: bwindham628120@direct.shands.ufl.edu

NPI Registry JSON

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679616000000",
    "number": "1093418402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 ASHLEY PL",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645338",
            "telephone_number": "228-219-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 ASHLEY PL",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645338",
            "telephone_number": "228-219-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINDHAM",
        "first_name": "BLAKE",
        "middle_name": "KENT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-24",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean Springs, MS

Sources for this page

Verify at the official NPI Registry.