Blake Allan Johnson

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

3016538 Issued in MA

Practice address

55 Fruit St GRB-425
Boston, MA 02114-2696

Phone

(617) 726-2800

NPI assigned

Dec 27, 2017

Last updated

Jun 6, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1164938288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST GRB 425",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST GRB-425",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BLAKE",
        "middle_name": "ALLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-27",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "3016538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriana Johnson
• Amanda Leann Johnson, MD
• Analise Johnson, PT
• Ayodeji David Johnson, M.D
• Benjamin Paul Johnson, M.D.
• Brian GS Johnson, R.N.
• Brielle Johnson, MA CCC-SLP
• Bruce Evan Johnson, MD
• Caitlin Johnson, NNP-BC
• Cameron Johnson, MD

• Surgery Physician in Boston, MA
• Providers in Boston, MA by specialty
• Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.