NPIMap

Organization Active NPI

Blake Gastroenterology Associates, LLC

  • Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1386729705
Registry record updated Jun 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
OS007404E Issued in PA
Legal business name
BLAKE GASTROENTEROLOGY ASSOCIATES, LLC
Practice address
6827-31 Germantown Ave
Philadelphia, PA 19119-2113
Phone
(215) 849-4902
Fax
(215) 849-4907
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2012

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

Authorized official

Name
James Steven Blake, DONPI 1720176381
Title
Ceo
Phone
(215) 849-4902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X OS007404E PA Primary

Addresses

Primary practice location

6827-31 Germantown Ave
Philadelphia, PA 19119-2113

Mailing address

6827-31 Germantown Ave
Philadelphia, PA 19119-2113
Phone (215) 849-4902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000714 PA Part B Supplier - Clinic/Group Practice 0648242685 Receives reassigned benefits from 1 practitioner
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340755200000",
    "number": "1386729705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6827-31 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192113",
            "telephone_number": "215-849-4902",
            "fax_number": "215-849-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6827-31 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192113",
            "telephone_number": "215-849-4902",
            "fax_number": "215-849-4907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE GASTROENTEROLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-06-27",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-849-4902",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "OS007404E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.