Active NPI
Joseph William Blake
- Behavior Technician
- Eden Prairie, MN
National Provider Identifier
1164174801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 7615 Golden Triangle Dr
Eden Prairie, MN 55344-3733 - Phone
- (612) 767-7222
- NPI assigned
- Jan 24, 2022
- Last updated
- Jan 24, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | NU | Primary |
Addresses
Primary practice location
7615 Golden Triangle Dr
Eden Prairie, MN 55344-3733
Mailing address
1831 Victoria Cir
Victoria, MN 55386-9688
Phone (952) 356-6307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JZD123793269001 | Other | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642982400000",
"number": "1164174801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1831 VICTORIA CIR",
"city": "VICTORIA",
"state": "MN",
"postal_code": "553869688",
"telephone_number": "952-356-6307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7615 GOLDEN TRIANGLE DR",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443733",
"telephone_number": "612-767-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "JOSEPH",
"middle_name": "WILLIAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-24",
"last_updated": "2022-01-24",
"certification_date": "2022-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "JZD123793269001",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.