NPIMap

Individual provider Active NPI

Blake Stucky

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1144843871
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-48234 Issued in KS
Practice address
1010 N Kansas St Ste 3023
Wichita, KS 67214-3124
Phone
(316) 293-2665
NPI assigned
May 28, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-48234 KS Primary
Family Medicine Physician 207Q00000X 94-10251 KS

Addresses

Primary practice location

1010 N Kansas St Ste 3023
Wichita, KS 67214-3124

Mailing address

1010 N Kansas St Ste 3023
Wichita, KS 67214-3124
Phone (316) 293-2665

Other practice location 1

911 N Main St
Garden City, KS 67846-5561
Phone (620) 276-8201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20230914000701 KS Practitioner - Family Practice 2860817061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commonspirit Kansas IncGroup PAC ID 4789595844, 62 clinicians

Practice addresses (Care Compare)

100 W Ross Blvd
Suite 1B
Dodge City, KS 67801-7217
Phone (620) 371-5576

401 E Spruce St
Garden City, KS 67846-5679
Phone (620) 272-2431

911 N Main St
SCHP Plaza Medical
Garden City, KS 67846-5561
Phone (620) 276-8201

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
30.79 of 100Reported as group
Quality
29.28
Promoting interoperability
0
Improvement activities
0
Cost
69.49

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04-48234KSMDFamily Medicine Physician
94-10251KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonspirit Kansas, Inc. Current Accepting new patients
St Catherine Hospital Family Medicine CurrentSince Sep 11, 2023 Accepting new patients
Commonspirit Kansas, Inc. Family Medicine CurrentSince Sep 11, 2023 Accepting new patients
Commonspirit Kansas, Inc. Family Medicine Past Accepting new patients
St. Catherine Hospital Family Medicine Past Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

100 W Ross Blvd
Ste 1B
Dodge City, KS 67801
Phone (620) 371-5576

911 N Main St
Garden City, KS 67846
Phone (316) 276-8201

401 E Spruce St
Garden City, KS 67846
Phone (620) 272-2222

Organizations & group practices 5

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

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1144843871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N KANSAS ST STE 3023",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143124",
            "telephone_number": "316-293-2665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N KANSAS ST STE 3023",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143124",
            "telephone_number": "316-293-2665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 N Main St",
            "address_purpose": "LOCATION",
            "city": "Garden City",
            "state": "KS",
            "postal_code": "678465561",
            "country_code": "US",
            "telephone_number": "620-276-8201",
            "fax_number": "620-276-8739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STUCKY",
        "first_name": "BLAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-28",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-48234",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "94-10251",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.