Active NPI
William K Blaylock
- Personal Emergency Response Attendant
- Norfolk, VA
National Provider Identifier
1396794947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Emergency Response Attendant
- License
- 0101044962
- Practice address
- 400 Gresham Dr
Medical Tower, Suite 702
Norfolk, VA 23507-1901 - Phone
- (757) 533-5437
- Fax
- (757) 533-5602
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Emergency Response Attendant | 146D00000X | 0101044962 | VA | Primary |
Addresses
Primary practice location
400 Gresham Dr
Medical Tower, Suite 702
Norfolk, VA 23507-1901
Mailing address
400 Gresham Dr
Medical Tower, Suite 702
Norfolk, VA 23507-1901
Phone (757) 533-5437
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0063-3042-8 | Medicaid | VA | |
| 240001577 | Other | VA | RR MEDICARE |
| 099122 | Other | VA | ANTHEM BCBS |
| 54-1546268 | Other | VA | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352160000000",
"number": "1396794947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 GRESHAM DR",
"address_2": "MEDICAL TOWER, SUITE 702",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235071901",
"telephone_number": "757-533-5437",
"fax_number": "757-533-5602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 GRESHAM DR",
"address_2": "MEDICAL TOWER, SUITE 702",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235071901",
"telephone_number": "757-533-5437",
"fax_number": "757-533-5602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAYLOCK",
"first_name": "WILLIAM",
"middle_name": "K",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2012-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "146D00000X",
"taxonomy_group": "",
"desc": "Personal Emergency Response Attendant",
"state": "VA",
"license": "0101044962",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0063-3042-8",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "240001577",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "099122",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "54-1546268",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.