Kimberly Thornton Blake, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9105774 Issued in FL

Practice address

1401 W Seminole Blvd
Sanford, FL 32771-6743

Phone

(800) 893-9698

NPI assigned

Jan 24, 2011

Sex

Female

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 FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment
• Clover Emergency Physicians LLC

  • Emergency Medicine Physician
  • St Petersburg, FL
  • NPI 1891744736
  NPD (past)

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1295030195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "address_2": "SUITE 201",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W SEMINOLE BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327716743",
            "telephone_number": "800-893-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KIMBERLY",
        "middle_name": "THORNTON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evan Todd Bitner, PTA
• BJ'S Wholesale Club Inc.
• Blacksheep Medicine LLC
• Dorrett C Blair
• Kyle Blair, PT
• Kyle Blake
• Stephan Blount, PHARM.D.
• Shikina Ninine Bodley, M.A. CCC SLP
• Kira Rio Boguslaw, LAC
• Lauren Elaine Bolander, MAT, LAT, ATC

• Physician Assistant in Sanford, FL
• Providers in Sanford, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; 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.

Verify at the official NPI Registry.