Individual provider Active NPI

Dorian R Blake, FNP

  • Family Nurse Practitioner
  • Englewood, CO
National Provider Identifier
1396233490
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
902855 Issued in MS
Practice address
175 Inverness Dr W Ste 300
Englewood, CO 80112-5069
Phone
(720) 516-0634
Fax
(720) 516-0237
NPI assigned
Apr 25, 2018
Last updated
Feb 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 902855 MS Primary

Addresses

Primary practice location

175 Inverness Dr W Ste 300
Englewood, CO 80112-5069

Mailing address

175 Inverness Dr W Ste 300
Englewood, CO 80112-5069
Phone (720) 516-0634

Other names 1

  • Dorian R Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230601002911 CO Practitioner - Nurse Practitioner 0446501852 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

175 Inverness Dr W
Suite 300
Englewood, CO 80112-5069
Phone (303) 265-3390

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
902855MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
Summit Headache and Neurologic Institute, PC CurrentSince May 10, 2023 Accepting new patients
Bienville Orthopaedic Specialists, LLC CurrentSince Aug 16, 2018 Accepting new patients
Bienville Orthopaedic Specialists, LLC CurrentSince Aug 16, 2018 Accepting new patients

Locations

175 Inverness Dr W
Ste 300
Englewood, CO 80112
Phone (720) 516-0634

601 E Hampden Ave
Ste 390
Englewood, CO 80113
Phone (303) 788-1430

1720A Medical Park Dr
Ste 220
Biloxi, MS 39532
Phone (228) 392-9355

6300 E Lake Blvd
Ste 201
Vancleave, MS 39565
Phone (228) 206-2263

6300 E Lake Blvd
Ste 301
Vancleave, MS 39565

Interoperability endpoints

  • Direct secure messaging: dblake@bienvilleortho.gwaydirect.com
  • FHIR API: https://api.platform.athenahealth.com/6818/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1396233490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 INVERNESS DR W STE 300",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801125069",
            "telephone_number": "720-516-0634",
            "fax_number": "720-516-0237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 INVERNESS DR W STE 300",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801125069",
            "telephone_number": "720-516-0634",
            "fax_number": "720-516-0237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "DORIAN",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-25",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DORIAN",
            "last_name": "CLARK",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Englewood, CO

Sources for this page

Verify at the official NPI Registry.