Paul Maxwell Blake III, MD
Individual provider Active NPI Internal Medicine Physician · Crystal River, FL
NPI 1366470148 · NPPES record last updated Apr 2, 2025
Key facts
- NPI
- 1366470148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- ME143213 (FL)
- Practice address
- 6201 N Suncoast Blvd
Crystal River, FL 34428-6712 - Phone
- (352) 795-8490
- Fax
- (352) 795-8555
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- West Florida Medical Associates, PA
Practice addresses (Care Compare)
6201 N Suncoast Blvd
Crystal River, FL 34428-6712
Phone (352) 795-8490
Hospital & facility affiliations
- Tampa General Hospital Crystal River
- Tampa General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051227000038 | WV | Practitioner - Internal Medicine | 1153343777 | Reassigns benefits to 3 organizations |
| I20250404002849 | FL | Practitioner - Internal Medicine | 1153343777 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME143213 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Florida Medical Associates, PA | Internal Medicine | Current |
Accepting new patients |
| Nature Coast Geriatric Services LLC | Current |
Accepting new patients | |
| West Florida Medical Associates P a | Internal Medicine | Current |
Accepting new patients |
| Racine Observation Medical Group, PLLC | Current |
Accepting new patients | |
| Allied West Virginia Emergency Physicians PLLC | Current |
Accepting new patients | |
| Hospitalist Medicine Physicians of West Virginia, PLLC | Internal Medicine | Current |
Accepting new patients |
Locations
3404 N Lecanto Hwy
Ste A
Beverly Hills, FL 34465
Phone (352) 513-4867
3404 N Lecanto Hwy
Ste C
Beverly Hills, FL 34465
Phone (352) 746-1558
3400 N Lecanto Hwy
#A
Beverly Hills, FL 34465
Phone (352) 746-2227
6201 N Suncoast Blvd
Crystal River, FL 34428
Phone (352) 527-0671
2900 1st Ave
Huntington, WV 25702
Phone (304) 526-1111
2900 1st Ave
Rm 1025
Huntington, WV 25702
Phone (304) 399-7484
2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 20938 | WV | |
| Internal Medicine Physician | 207R00000X | ME143213 | FL | Yes |
| Internal Medicine Physician | 207R00000X | MD429954 | PA |
Addresses
Primary practice location
6201 N Suncoast Blvd
Crystal River, FL 34428-6712
Mailing address
PO Box 640573
Beverly Hills, FL 34464-0573
Phone (352) 795-8490
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2341602 | Medicaid | OH | |
| 1896405 | Other | PA | HIGHMARK |
| 181232700 | Medicaid | WV | |
| 105606 | Other | PA | MEDICARE |
| 1017240800001 | Medicaid | PA | |
| 64073695 | Medicaid | KY |
Other providers in Crystal River, FL
- Better Health Chiropractic PA
- David Michael Bibbey
- Bikkasani Ram Hellstern and Chandrupatla Mdpa
- Purnachander R Bikkasani
- Edawrd Birkler
- Blessed Endocare
- Blessed Ones Home Care, LLC
- Erin Lee Blom
- Albert M. Boholst
- Nicholos P Bollin
All providers in Crystal River, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.