Jon Kevin Blake MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

JON KEVIN BLAKE MD

Practice address

925 E Main St
Gas City, IN 46933-1550

Phone

(765) 674-7889

NPI assigned

May 12, 2020

Organization subpart

No

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

Authorized official

Name

Jon Blake, MD

Title

Authorized Official/Physician

Phone

(765) 674-7889

Specialties & licenses 1

Addresses

Other names 1

• Jon K. Blake MD Doing business as

Locations

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1215559331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1889",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473081889",
            "telephone_number": "765-284-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 E MAIN ST",
            "city": "GAS CITY",
            "state": "IN",
            "postal_code": "469331550",
            "telephone_number": "765-674-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JON KEVIN BLAKE MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/PHYSICIAN",
        "authorized_official_telephone_number": "765-674-7889",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jon K. Blake MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Gas City, IN
• General Practice Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.