Active NPI
Blake Knudson Isom, DO
- Emergency Medicine Physician
- Harrisburg, PA
National Provider Identifier
1336433788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- OS016812
- Practice address
- 111 S Front St
Harrisburg, PA 17101-2010 - Phone
- (717) 988-0000
- Fax
- (717) 782-5716
- NPI assigned
- Jun 2, 2011
- 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | OS016812 | PA | Primary |
Addresses
Primary practice location
111 S Front St
Harrisburg, PA 17101-2010
Mailing address
409 S 2ND St
Suite 2F
Harrisburg, PA 17104-1612
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102949254 | Medicaid | PA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bisom8129@phsdirect.pinnaclehealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
111 S Front St
Harrisburg, PA 17101-2010
409 S 2ND St
Harrisburg, PA 17104-1612
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.46 of 100
- Quality
- 92.17
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 78.87
Merit-based Incentive Payment System (MIPS)
- Final score
- 79.36 of 100
- Quality
- 56.69
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.52
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS016812 | PA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pinnacle Health Emergency Department Services LLC | Emergency Medicine | Current | Accepting new patients |
| Pinnacle Health Observation Services LLC | Emergency Medicine | Current | Accepting new patients |
Locations
409 S 2nd St
Ste 2F
Harrisburg, PA 17104
Phone (717) 231-8049
111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282
Interoperability endpoints
- bisom291592@upmc.direct-ci.com
Organizations & group practices 2
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 Physician
- Harrisburg, PA
- NPI 1487693404
-
- Emergency Medicine Physician
- Harrisburg, PA
- NPI 1316341241
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Harrisburg, PA
- NPI 1265537674
-
- General Acute Care Hospital
- Harrisburg, PA
- NPI 1407813603
-
dba UPMC Pinnacle West Shore
- General Acute Care Hospital
- Mechanicsburg, PA
- NPI 1972613305
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610755200000",
"number": "1336433788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 S 2ND ST",
"address_2": "SUITE 2F",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171041612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 S FRONT ST",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171012010",
"telephone_number": "717-988-0000",
"fax_number": "717-782-5716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISOM",
"first_name": "BLAKE",
"middle_name": "KNUDSON",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-02",
"last_updated": "2021-01-16",
"certification_date": "2021-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "PA",
"license": "OS016812",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102949254",
"state": "PA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "bisom8129@phsdirect.pinnaclehealth.org",
"affiliation": "N",
"address_1": "111 S Front St",
"city": "Harrisburg",
"state": "PA",
"country_code": "US",
"postal_code": "171012010",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Harrisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.