John C Blake

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

0017165 Issued in WI

Practice address

50 Pearl Ave Ste 102
Oshkosh, WI 54901-4811

Phone

(414) 345-7781

Fax

(866) 496-2680

NPI assigned

Feb 19, 2025

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1134924475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2844 MONTCLAIR PL",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549048944",
            "telephone_number": "414-345-7781",
            "fax_number": "866-496-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 PEARL AVE STE 102",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549014811",
            "telephone_number": "414-345-7781",
            "fax_number": "866-496-2680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2323 Lake Club Dr Ste 301",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432323198",
            "country_code": "US",
            "telephone_number": "614-456-4999",
            "fax_number": "896-268-0664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JOHN",
        "middle_name": "C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": "0017165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Harold W Boccheciamp, MD

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.