Individual provider Active NPI

Blake Michael Leblanc

  • Internal Medicine Physician
  • Jackson, MS
National Provider Identifier
1356928246
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
33165 Issued in MS
Practice address
1190 N State St Ste 403
Jackson, MS 39202-2413
Phone
(769) 268-6770
Fax
(769) 268-6769
NPI assigned
Mar 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 33165 MS Primary

Addresses

Primary practice location

1190 N State St Ste 403
Jackson, MS 39202-2413

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177
Phone (901) 226-4003

Other practice location 1

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5601

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250611003438 MS Practitioner - Internal Medicine 2668877465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in Shreveport, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Foundation of Central Mississippi IncGroup PAC ID 1153216411, 274 clinicians

Practice addresses (Care Compare)

1190 N State St
Jackson, MS 39202-2413
Phone (769) 268-6770

Hospital & facility affiliations

  • Mississippi Baptist Medical Center Hospital, Jackson, MS, CCN 250102

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33165MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Foundation of Central Mississippi, Inc. Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Medical Foundation of Central Ms CurrentSince Aug 1, 2025 Accepting new patients

Locations

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

1190 N State St
Ste 403
Jackson, MS 39202
Phone 6013532020 ext. 138

401 Baptist Dr
Ste 104
Madison, MS 39110
Phone (601) 605-2383

350 N Humphreys Blvd
Memphis, TN 38120
Phone (901) 226-4003

Interoperability endpoints

  • Direct secure messaging: blake.leblanc.1@20428.direct.athenahealth.com
  • Direct secure messaging: bleblanc691248@direct.bmhcc.org

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.

Hospital & facility affiliations 1

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": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1356928246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177",
            "telephone_number": "901-226-4003",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 N STATE ST STE 403",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022413",
            "telephone_number": "769-268-6770",
            "fax_number": "769-268-6769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-984-5601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEBLANC",
        "first_name": "BLAKE",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-26",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "33165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.