Individual provider Active NPI

Eugenia Blake

  • Advanced Practice Midwife
  • Mount Pleasant, SC
National Provider Identifier
1104001551
Registry record updated Jan 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
3452 Issued in SC
Practice address
1300 Hospital Dr
Suite 270
Mt Pleasant, SC 29464-3261
Phone
(843) 884-5133
Fax
(843) 972-2360
NPI assigned
Jan 4, 2008
Last updated
Jan 4, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 3452 SC Primary

Addresses

Primary practice location

1300 Hospital Dr
Suite 270
Mt Pleasant, SC 29464-3261

Mailing address

1300 Hospital Dr
Suite 270
Mt Pleasant, SC 29464-3261
Phone (843) 884-5133

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150623000478 SC Practitioner - Certified Nurse Midwife (CNM) 6901117613 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
3452SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Edmund Rhett, Jr., M.D., P.a. CurrentSince Apr 30, 2015 Accepting new patients

Locations

1300 Hospital Dr
Ste 150
Mt Pleasant, SC 29464
Phone (843) 375-2210

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1199404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199404800000",
    "number": "1104001551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 HOSPITAL DR",
            "address_2": "SUITE 270",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643261",
            "telephone_number": "843-884-5133",
            "fax_number": "843-972-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 HOSPITAL DR",
            "address_2": "SUITE 270",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643261",
            "telephone_number": "843-884-5133",
            "fax_number": "843-972-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "EUGENIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-04",
        "last_updated": "2008-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "SC",
            "license": "3452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.