Blake Hansen, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-12376 Issued in AR

Practice address

4803 W Highland Knolls Rd Ste 150
Rogers, AR 72758-6255

Phone

(479) 337-7521

Fax

(479) 888-1408

NPI assigned

May 12, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 22, 2023 through Sep 22, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Hansen Medical LLC

  • Primary Care Clinic/Center
  • Rogers, AR
  • NPI 1336824531
  NPD Authorized official
• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  NPD (past)

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1285080853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4803 W HIGHLAND KNOLLS RD STE 150",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727586255",
            "telephone_number": "479-337-7521",
            "fax_number": "479-888-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4803 W HIGHLAND KNOLLS RD STE 150",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727586255",
            "telephone_number": "479-337-7521",
            "fax_number": "479-888-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "BLAKE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-12",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-12376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://simplified-health.hint.com/login/request",
            "affiliation": "N",
            "address_1": "4803 W Highland Knolls Rd Ste 150",
            "city": "Rogers",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727586255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Merideth Karen Hanks, APN
• Vera Caroline Ann Hanna, APRN
• Martin A Hannon, MD
• Hansen Medical LLC
• Adrienne Hansen, M.S. CCC-SLP
• Kylee N Hansen
• Scott Eric Hansen, PHARM. D
• Mia Hanson
• Katlin Hardin
• Laura Ann Hardin, LMSW

• Family Medicine Physician in Rogers, AR
• Providers in Rogers, 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 Mar 14, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.