Bleck Exilus

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP031538 Issued in PA

Practice address

14-20 Macdade Blvd Ste a
Darby, PA 19023-1822

Phone

(610) 522-4506

NPI assigned

Dec 4, 2024

Last updated

Dec 4, 2024By the provider in NPPES

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Damian Family Care Centers, Inc.Group PAC ID 6507849882, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Damian Family Care Centers, Inc.

  dba Project Samaritan Health Services

  • Federally Qualified Health Center (FQHC)
  • Jamaica, NY
  • NPI 1508955592

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Aviva Mental Health Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Collingdale, PA
  • NPI 1083110605

  Single Specialty

  NPD
• Damian Family Care Centers, Inc.

  dba Project Samaritan Health Services

  • Federally Qualified Health Center (FQHC)
  • Jamaica, NY
  • NPI 1487923595
  NPD

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1134935273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14-20 MACDADE BLVD STE A",
            "city": "DARBY",
            "state": "PA",
            "postal_code": "190231822",
            "telephone_number": "610-522-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14-20 MACDADE BLVD STE A",
            "city": "DARBY",
            "state": "PA",
            "postal_code": "190231822",
            "telephone_number": "610-522-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EXILUS",
        "first_name": "BLECK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP031538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Eglick Harkavy, MD
• Arnold Robert Eiser, MD
• Elite Dental LLC
• Elpat Home Health Agency LLC
• Evod Body Solutions LLC (Dove Online Training)
• Ryaan Babikir Fadul
• Margaret Joan Fagan, CRNP
• Dianna C. Falkowitz, MD
• Family Best Home Care LLC
• Matthew Farrell

• Psychiatric/Mental Health Nurse Practitioner in Darby, PA
• Providers in Darby, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.