NPIMap

Individual provider Active NPI

Jacob L Blake, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Reno, NV
National Provider Identifier
1154486769
Registry record updated Jan 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
14407 Issued in NV
Practice address
5590 Kietzke LN
Reno, NV 89511-3019
Phone
(775) 323-2080
Fax
(775) 683-9404
NPI assigned
Dec 26, 2006
Last updated
Jan 29, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2019

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
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 Primary

Addresses

Primary practice location

5590 Kietzke LN
Reno, NV 89511-3019

Mailing address

5590 Kietzke LN
Reno, NV 89511-3019
Phone (775) 323-2080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120921000229 NV Practitioner - Pain ManagementPractitioner - Anesthesiology 4385796598 Reassigns benefits to 1 organization
I20151209001596 CA Practitioner - Pain Management 4385796598 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Custom Physical Therapy Limited PartnershipGroup PAC ID 1355252842, shared by 2 NPIs, 76 clinicians
Sierra Neurosurgery GroupGroup PAC ID 3870588619, 24 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
90.71 of 100Reported as apm
Quality
81.42
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A95206CAMDAnesthesiology Physician
14407NVMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sierra Neurosurgery Group CurrentSince Oct 1, 2012 Accepting new patients
St. Mary's Outpatient Surgery Center at Galena LLC Current Accepting new patients
Sierra Neurosurgery Group CurrentSince Oct 1, 2012 Accepting new patients
Renown Regional Medical Center Past Accepting new patients
South Lyon Health Center, Inc. Past Accepting new patients
Sparks Family Hospital 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

  • FHIR API: https://api.platform.athenahealth.com/13729/brand/6/csg/1/fhir/r4

Organizations & group practices 8

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 12

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": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1154486769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5590 KIETZKE LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895113019",
            "telephone_number": "775-323-2080",
            "fax_number": "775-323-8216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5590 KIETZKE LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895113019",
            "telephone_number": "775-323-2080",
            "fax_number": "775-683-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JACOB",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NV",
            "license": "14407",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A95206",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD60071790",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A95206",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "WA",
            "license": "MD60071790",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NV",
            "license": "14407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.