Jacob L Blake, M.D.
Individual provider Active NPI Pain Medicine (Anesthesiology) Physician · Reno, NV
NPI 1154486769 · NPPES record last updated Jan 29, 2019
Key facts
- NPI
- 1154486769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pain Medicine (Anesthesiology) Physician 207LP2900X
- License
- 14407 (NV)
- Practice address
- 5590 Kietzke LN
Reno, NV 89511-3019 - Phone
- (775) 323-2080
- Fax
- (775) 683-9404
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 12
Medicare Care Compare profile
- Specialty
- Pain Management
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Custom Physical Therapy Limited Partnership
Sierra Neurosurgery Group
Practice addresses (Care Compare)
440 E Golden Valley Rd
Reno, NV 89506-5722
Phone (775) 360-3000
5590 Kietzke LN
Reno, NV 89511-3019
Phone (775) 323-2080
Hospital & facility affiliations
- Renown Regional Medical Center
- Renown South Meadows Medical Center
- Carson Tahoe Regional Medical Center
- Northern Nevada Medical Center
- Banner Lassen Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.71 of 100
- Quality
- 81.42
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NV, CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120921000229 | NV | Practitioner - Pain Management |
4385796598 | Reassigns benefits to 1 organization |
| I20151209001596 | CA | Practitioner - Pain Management | 4385796598 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14407 | NV | MD | Anesthesiology Physician |
| A95206 | CA | MD | Pain Medicine (Anesthesiology) Physician |
| MD60071790 | WA | MD | Pain Medicine (Anesthesiology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Mary'S Outpatient Surgery Center at Galena LLC | Current | Accepting new patients | |
| Sierra Neurosurgery Group | Current |
Accepting new patients | |
| Sierra Neurosurgery Group | Current |
Accepting new patients | |
| Renown Regional Medical Center | Past | Accepting new patients | |
| Sparks Family Hospital Inc | Past | Accepting new patients | |
| South Lyon Health Center, Inc. | Past | Accepting new patients | |
| Prime Healthcare Services - Reno LLC | Past | Accepting new patients | |
| Mt Grant General Hospital | Past | Accepting new patients |
Locations
5590 Kietzke Ln
Reno, NV 89511
Phone (775) 323-2080
5070 Ion Dr
Ste 200
Sparks, NV 89436
Phone (775) 323-2080
Interoperability endpoints
- https://api.platform.athenahealth.com/13729/brand/6/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 14407 | NV | |
| Anesthesiology Physician | 207L00000X | A95206 | CA | |
| Anesthesiology Physician | 207L00000X | MD60071790 | WA | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | A95206 | CA | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | MD60071790 | WA | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 14407 | NV | Yes |
Addresses
Primary practice location
5590 Kietzke LN
Reno, NV 89511-3019
Mailing address
5590 Kietzke LN
Reno, NV 89511-3019
Phone (775) 323-2080
Other providers in Reno, NV
- Tracy Lee Blair
- Wendy Blair
- Delia Blaisdell
- Alexandra Leigh Blake
- Conrad James Blake
- Kenneth Blake
- Kimberly Blake
- Timothy Blake
- William Blake
- Tiffany Marie Blakeman
All providers in Reno, NV · Pain Medicine (Anesthesiology) Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.