Sheryl Alice Blake, MSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LW60634799 Issued in WA

Practice address

24920 104TH Ave SE
Kent, WA 98030-6443

Phone

(425) 690-7592

Fax

(425) 690-9414

NPI assigned

Sep 29, 2016

Last updated

Aug 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

University of Washington School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sblake62049@direct.valleymed.org

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.

• Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1619209574
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1285183384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 LIND AVE SW",
            "address_2": "SUITE 100 ATTN CREDENTIALING",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574970",
            "telephone_number": "425-690-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24920 104TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306443",
            "telephone_number": "425-690-7592",
            "fax_number": "425-690-9414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4445 Talbot Rd S",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980556219",
            "country_code": "US",
            "telephone_number": "425-690-7592",
            "fax_number": "425-690-9414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SHERYL",
        "middle_name": "ALICE",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW60634799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2068863",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sblake62049@direct.valleymed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sblake62049@direct.valleymed.org",
            "address_1": "24920 104th Ave SE",
            "city": "Kent",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980306443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://FHIR.valleymed.org/FHIR-PRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "24920 104th Ave SE",
            "city": "Kent",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980306443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• BJ Kim
• Eva Blacconiere, DPT
• Nicole Marie Black
• Blackburn Clinic, Inc. PS (Rebound)
• William Kelly Blackburn, MASSAGE THERAPY
• Aisa Marie Blanchard, BS
• Matthew S Blessing, MD
• Joshua Bleustar, LMHC, NCC, ADS
• Lacey M Bliss, ARNP
• Kennajha Bloodsaw

• Social Worker in Kent, WA
• Providers in Kent, WA by specialty
• Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.
• 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.