NPIMap

Individual provider Active NPI

Blake Kent Williams, M.D., CAQSM

  • Family Medicine Physician
  • Great Barrington, MA
National Provider Identifier
1164764684
Registry record updated May 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
272651 Issued in MA
Practice address
780 Main St Ste 102
Great Barrington, MA 01230
Phone
(413) 528-8643
NPI assigned
Mar 22, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 272651 MA
Family Medicine Physician 207Q00000X 272651 MA Primary

Addresses

Primary practice location

780 Main St Ste 102
Great Barrington, MA 01230

Mailing address

8414 Naab Rd Ste 120
Indianapolis, IN 46260-1972
Phone (317) 338-7584

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20171221001418 MA Practitioner - Family PracticePractitioner - Sports Medicine 2466685490 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Indiana University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview HospitalGroup PAC ID 1254240773, 56 clinicians

Practice addresses (Care Compare)

780 Main St
Great Barrington, MA 01230-2148
Phone (413) 528-8290

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
272651MAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Hospital Current Accepting new patients
Fairview Hospital CurrentSince Feb 1, 2020 Accepting new patients
Fairview Hospital CurrentSince Oct 16, 2017 Accepting new patients
Berkshire Faculty Services Inc CurrentSince Oct 16, 2017 Accepting new patients
Fairview Hospital CurrentSince Feb 1, 2020 Accepting new patients
Moses Cone Affiliated Physicians, Inc Past Accepting new patients

Locations

29 Lewis Ave
Gt Barrington, MA 01230
Phone (413) 528-0790

780 S Main St
Ste 2
Gt Barrington, MA 01230
Phone (413) 447-2498

725 North St
Pittsfield, MA 01201
Phone (413) 447-2839

Interoperability endpoints

  • Direct secure messaging: blakewilliams@fvh.medalliesdirect.net

Organizations & group practices 6

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 6

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": "1363910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1164764684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8414 NAAB RD STE 120",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601972",
            "telephone_number": "317-338-7584",
            "fax_number": "317-338-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 MAIN ST STE 102",
            "city": "GREAT BARRINGTON",
            "state": "MA",
            "postal_code": "01230",
            "telephone_number": "413-528-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "BLAKE",
        "middle_name": "KENT",
        "name_prefix": "Dr.",
        "credential": "M.D., CAQSM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-22",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MA",
            "license": "272651",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "272651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Barrington, MA

Sources for this page

Verify at the official NPI Registry.