Blake Surgical Association PLLC

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

16881 Issued in MS

Legal business name

BLAKE SURGICAL ASSOCIATION PLLC

Practice address

907 E Sunflower Rd #101
Cleveland, MS 38732-2833

Phone

(662) 846-8880

NPI assigned

Jul 24, 2007

Last updated

Aug 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Roger Blake, M.D.NPI 1023049335

Title

Owner/Physician

Phone

(662) 846-8880

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roger Alan Blake, M.D.

  • Surgical Critical Care Physician
  • Cleveland, MS
  • NPI 1023049335
  Authorized official Same address or phone

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598745600000",
    "number": "1154521466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD",
            "address_2": "101",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322830",
            "telephone_number": "662-846-8880",
            "fax_number": "662-846-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD #101",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322833",
            "telephone_number": "662-846-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE SURGICAL ASSOCIATION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2020-08-30",
        "certification_date": "2020-08-30",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "662-846-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MS",
            "license": "16881",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MS",
            "license": "16881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "C03406",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122620",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "020000545",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Medical Clinic
• Bethany Medical Clinic, LLC
• Tracy Marie Blackstock
• Don Blackwood, MD
• Mark Edward Blackwood, MD
• Roger Alan Blake, M.D.
• Bolivar County Caa
• Bolivar County Council on Aging, Inc.
• Bolivar Emergency Group LLC
• Bolivar ENT, Inc

• Surgical Critical Care Physician in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Surgical Critical Care Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2020; 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.