Individual provider Active NPI

Blake William Ferry

  • Advanced Practice Midwife
  • Shiloh, IL
National Provider Identifier
1407652159
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
209.031440 Issued in IL
Practice address
1170 Fortune Blvd
Shiloh, IL 62269-7358
Phone
(618) 997-5266
NPI assigned
Feb 24, 2025
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 209.031440 IL Primary

Addresses

Primary practice location

1170 Fortune Blvd
Shiloh, IL 62269-7358

Mailing address

12 Orchard Dr
Charleston, IL 61920-3349
Phone (217) 549-8740

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250319003003 IL Practitioner - Certified Nurse Midwife (CNM) 3779005780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heartland Women's Healthcare LTDGroup PAC ID 1759270648, 29 clinicians

Practice addresses (Care Compare)

1170 Fortune Blvd
Shiloh, IL 62269-7358
Phone (618) 997-5266

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
209.031440ILMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Women's Healthcare LTD CurrentSince Apr 12, 2025 Accepting new patients
Heartland Women's Healthcare LTD CurrentSince Apr 12, 2025 Accepting new patients
Heartland Women's Healthcare Il PC Past Accepting new patients

Locations

900 E Walnut St
Ste 10
Carbondale, IL 62901

3408 Office Park Dr
Marion, IL 62959
Phone (318) 997-5266

3130 Veterans Memorial Dr
Mount Vernon, IL 62864
Phone (708) 736-1727

3230 Veterans Memorial Dr
Mount Vernon, IL 62864

1170 Fortune Blvd
Shiloh, IL 62269
Phone (205) 246-5690

1197 Fortune Blvd
Shiloh, IL 62269

6 Park Pl
Swansea, IL 62226
Phone (618) 233-0522

Interoperability endpoints

  • Direct secure messaging: blake.ferry.1@21608.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1407652159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ORCHARD DR",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203349",
            "telephone_number": "217-549-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697358",
            "telephone_number": "618-997-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERRY",
        "first_name": "BLAKE",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IL",
            "license": "209.031440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shiloh, IL

Sources for this page

Verify at the official NPI Registry.