Blake William McGowan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E4101 Issued in AR

Practice address

500 S University Ave
Suite 808
Little Rock, AR 72205-5302

Phone

(501) 660-4484

Fax

(501) 660-4490

NPI assigned

Sep 14, 2005

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

Other identifiers 3

Other names 1

• W. Blake McGowan Other name

Medicare fee-for-service enrollment

Enrolled in GA

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

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: william.mcgowan.1@18142.direct.athenahealth.com

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.

• Galileo Medical Group Ga, P.C.

  • Family Medicine Physician
  • New York, NY
  • NPI 1245920305

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1174518229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "SUITE 808",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055302",
            "telephone_number": "501-660-4484",
            "fax_number": "501-660-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "SUITE 808",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055302",
            "telephone_number": "501-660-4484",
            "fax_number": "501-660-4490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "64 Bleecker St # 151",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100122410",
            "country_code": "US",
            "telephone_number": "302-313-1584",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGOWAN",
        "first_name": "BLAKE",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E4101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "01-01185",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "04080013400",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RALROAD MEDICARE",
            "identifier": "P00168487",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "W.",
            "last_name": "MCGOWAN",
            "middle_name": "BLAKE",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ralph Scott McGill
• Cecelia McGilvray, LCSW
• Larry Michael McGinnis, PHARM D
• Nohora Constanza McGinty, PHARM D
• Katie Ann McGlone, MS,CFY-SLP
• Robert J McGowan Jr., M.D.
• Vicki M McGowan, MHPP
• Cherry McGrath, APN
• Tyler McGrath
• Renee Peldun McGraw, MD

• Family Medicine Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.