Jennifer Danielle Bleck

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2725 Mendocino Ave
Santa Rosa, CA 95403

Phone

(707) 545-4537

NPI assigned

Nov 13, 2019

Last updated

Jan 6, 2023By 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

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Loma Linda University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Redwood Fam Dermatology Medical Associates - a Medical CorporationGroup PAC ID 0446243034, 18 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.97 of 100Reported as group

Quality

100

Improvement activities

40

Cost

76.57

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: jbleck@rfd.emadirect.md

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.

• Redwood Fam Dermatology Medical Associates - a Medical Corporation

  dba Redwood Family Dermatology

  • Dermatology Physician
  • Santa Rosa, CA
  • NPI 1710913231
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1326683350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 MENDOCINO AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032805",
            "telephone_number": "707-545-4537",
            "fax_number": "707-545-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 MENDOCINO AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95403",
            "telephone_number": "707-545-4537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6571 W 84th St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900452852",
            "country_code": "US",
            "telephone_number": "310-650-0580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLECK",
        "first_name": "JENNIFER",
        "middle_name": "DANIELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-13",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary A Blank, PH.D.
• Jillian M Blank
• Morkeh Blay-Tofey, MD, MBA
• BLC Lodge at Paulin LP (Brookdale Paulin Creek)
• Thomas Perry Blechel, PT
• Wolfgang R. Bley, MD
• Conrad E Block, DDS
• Mitchell Blomseth
• Blood Bank of the Redwoods
• David-James Bloom, MD

• Physician Assistant in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; 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.