Shaun Roland Blake, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

38074 Issued in CA

Practice address

332 Santa Fe Dr
Ste 120
Encinitas, CA 92024-5143

Phone

(760) 942-4400

Fax

(760) 942-4450

NPI assigned

Jul 21, 2011

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 SD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Avera McKennan

  dba Avera McKennan Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sioux Falls, SD
  • NPI 1699009944
  Medicare reassignment Care Compare group NPD
• City of Brookings

  dba Brookings Health System

  • Anesthesiology Physician
  • Brookings, SD
  • NPI 1932281029
  Medicare reassignment NPD
• Sacred Heart Health Services

  dba Avera Sacred Heart Hospital

  • Emergency Care Clinic/Center
  • Yankton, SD
  • NPI 1861611683
  Medicare reassignment NPD
• Avera McKennan

  dba Avera Interventional Radiology

  • Diagnostic Radiology Physician
  • Sioux Falls, SD
  • NPI 1053680678
  NPD
• City of Brookings

  dba Avera Medical Group a Department of Brookings Health System

  • Multi-Specialty Clinic/Center
  • Brookings, SD
  • NPI 1134558158
  NPD
• City of Brookings

  dba Brookings Health System Arlington Medical Center

  • Rural Health Clinic/Center
  • Arlington, SD
  • NPI 1902123581
  NPD
• Sacred Heart Health Services

  dba Avera Therapy Hartington

  • Physical Therapist
  • Yankton, SD
  • NPI 1053838508
  NPD
• Sacred Heart Health Services

  • General Practice Physician
  • Yankton, SD
  • NPI 1205703659
  NPD
• Stac Physical Therapy Pfi, Inc

  dba Personally Fit , Inc

  • Physical Therapist
  • San Diego, CA
  • NPI 1427703354
  NPD (past)
• Avera McKennan

  dba Avera Medical Group

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1376575514
  NPD (past)

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1255619490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 SANTA FE DR",
            "address_2": "STE 120",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920245143",
            "telephone_number": "760-942-4400",
            "fax_number": "760-942-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 SANTA FE DR",
            "address_2": "STE 120",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920245143",
            "telephone_number": "760-942-4400",
            "fax_number": "760-942-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SHAUN",
        "middle_name": "ROLAND",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "38074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Black Mountain Healthcare LLC (Seaport Hospice)
• Monica Marie Black, DPT
• Richard Michael Black, DMD
• David Michael Blair, L.M.F.T.
• Sherine Blair, L.AC.
• Torrey Blake, OT
• Blanaced Body Therapeutic Massage
• Drew Cameron Blanchard, PT DPT
• Kim Blankemeier
• Vanessa Anne Blasic, PA-C

• Physical Therapist in Encinitas, CA
• Providers in Encinitas, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.