Active NPI
Nicholas Blakely, PA-C
- Physician Assistant
- San Juan Capistrano, CA
National Provider Identifier
1275345753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA66041
- Practice address
- 30230 Rancho Viejo Rd Ste 200
San Juan Capistrano, CA 92675-1585 - Phone
- (949) 443-4303
- Fax
- (949) 443-4033
- NPI assigned
- Jan 22, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA66041 | CA | Primary |
Addresses
Primary practice location
30230 Rancho Viejo Rd Ste 200
San Juan Capistrano, CA 92675-1585
Mailing address
PO Box 7087
Orange, CA 92863-7087
Phone (714) 571-5000
Other practice location 1
23141 Moulton Pkwy Ste 108
Laguna Hills, CA 92653-1241
Phone (949) 443-4303
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66041 | CA | MD | Pharmacist |
| PA66041 | CA | MD | Physician Assistant |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772496000000",
"number": "1275345753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7087",
"city": "ORANGE",
"state": "CA",
"postal_code": "928637087",
"telephone_number": "714-571-5000",
"fax_number": "714-571-5055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30230 RANCHO VIEJO RD STE 200",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926751585",
"telephone_number": "949-443-4303",
"fax_number": "949-443-4033"
}
],
"practiceLocations": [
{
"address_1": "23141 Moulton Pkwy Ste 108",
"address_purpose": "LOCATION",
"city": "Laguna Hills",
"state": "CA",
"postal_code": "926531241",
"country_code": "US",
"telephone_number": "949-443-4303",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLAKELY",
"first_name": "NICHOLAS",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-22",
"last_updated": "2026-03-03",
"certification_date": "2026-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA66041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan Capistrano, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; 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.