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Individual provider Active NPI

Joshua Daniel Blake, NP

  • Family Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1104593102
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0995796-NP Issued in CO
Practice address
1400 E Boulder St
Colorado Springs, CO 80909-5533
Phone
(719) 365-5000
NPI assigned
Aug 26, 2021
Last updated
Jul 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0995796-NP CO Primary

Addresses

Primary practice location

1400 E Boulder St
Colorado Springs, CO 80909-5533

Mailing address

PO Box 173891
Denver, CO 80217-3891
Phone (877) 346-2211

Other identifiers 1

IdentifierTypeStateIssuer
9000198637MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211027000538 CO Practitioner - Nurse Practitioner 8628466562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1400 E Boulder St
Memorial Health System
Colorado Springs, CO 80909-5533
Phone (719) 365-6820

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medical Specialists, PC CurrentSince Jun 9, 2025 Accepting new patients
Emergency Medical Specialists, PC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Feb 14, 2022 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Feb 14, 2022 Accepting new patients
Emergency Medical Specialists, PC CurrentSince Jun 9, 2025 Accepting new patients
Summit Primary Care PastSince May 1, 2020 Accepting new patients

Locations

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

4050 Briargate Pkwy
Colorado Springs, CO 80920
Phone (719) 364-5000

9480 Briar Village Pt
Ste 200
Colorado Springs, CO 80920
Phone (719) 278-3627

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 6

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1104593102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 173891",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802173891",
            "telephone_number": "877-346-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-365-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JOSHUA",
        "middle_name": "DANIEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-26",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0995796-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000198637",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.