NPIMap

Individual provider Active NPI

Blake Paul Gillette, MD

  • Orthopaedic Surgery Physician
  • Spanish Fork, UT
National Provider Identifier
1356579213
Registry record updated Aug 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
3615241205 Issued in UT
Practice address
325 W Center St
Spanish Fork, UT 84660-2060
Phone
(801) 798-7301
NPI assigned
Jun 30, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Orthopaedic Surgery Physician 207X00000X 53004 MN
Orthopaedic Surgery Physician 207X00000X 3615241205 UT Primary

Addresses

Primary practice location

325 W Center St
Spanish Fork, UT 84660-2060

Mailing address

325 W Center St
Spanish Fork, UT 84660-2060
Phone (801) 798-7301

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN
ENROLLEDMedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150812009130 UT Practitioner - Orthopedic Surgery 6800080714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Ohio State University College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1157 N 300
Suite 201
Provo, UT 84604-6124
Phone (801) 357-1200

Hospital & facility affiliations

  • Canyon Home Care Home health agency, Murray, UT, CCN 467226
  • Community Nursing Services Home health agency, West Valley City, UT, CCN 467001
  • Mountain View Hospital Hospital, Payson, UT, CCN 460013
  • Intermountain Health Spanish Fork Hospital Hospital, Spanish Fork, UT, CCN 460062
  • Timpanogos Regional Hospital Hospital, Orem, UT, CCN 460052
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023
  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement86
Lower limb (leg) arthroscopy (minimally invasive joint repair)15
Upper limb (arm) arthroscopy (minimally invasive joint repair)96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
129427CAMDMarriage & Family Therapist
53004MNMDOrthopaedic Surgery Physician
3615241205UTMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Dec 10, 2020 Accepting new patients
Ihc Health Services, Inc. CurrentSince Dec 10, 2020 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients
Utah Valley Surgery Center, LLC PastSince Dec 8, 2016 Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

1157 N 300 W
Ste 201
Provo, UT 84604
Phone (801) 357-1200

819 E Market Place Dr
Spanish Fork, UT 84660
Phone (385) 344-6600

Interoperability endpoints

  • Direct secure messaging: kmu8042@yourcarecommunity.org

Organizations & group practices 5

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440547200000",
    "number": "1356579213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W CENTER ST",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846602060",
            "telephone_number": "801-798-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W CENTER ST",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846602060",
            "telephone_number": "801-798-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLETTE",
        "first_name": "BLAKE",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-30",
        "last_updated": "2015-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "53004",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "UT",
            "license": "3615241205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spanish Fork, UT

Sources for this page

Verify at the official NPI Registry.