Blake William Ferry
Individual provider Active NPI Advanced Practice Midwife · Shiloh, IL
NPI 1407652159 · NPPES record last updated Feb 24, 2025
Key facts
- NPI
- 1407652159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Advanced Practice Midwife 367A00000X
- License
- 209.031440 (IL)
- Practice address
- 1170 Fortune Blvd
Shiloh, IL 62269-7358 - Phone
- (618) 997-5266
- NPI assigned
- Feb 24, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- 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 LTD
Practice addresses (Care Compare)
1170 Fortune Blvd
Shiloh, IL 62269-7358
Phone (618) 997-5266
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250319003003 | IL | Practitioner - Certified Nurse Midwife (CNM) | 3779005780 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.031440 | IL | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heartland Women'S Healthcare LTD | Current |
Accepting new patients | |
| Heartland Women'S Healthcare LTD | Current |
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 6189975266 ext. 176
3230 Veterans Memorial Dr
Mount Vernon, IL 62864
3130 Veterans Memorial Dr
Mount Vernon, IL 62864
Phone (708) 736-1727
1197 Fortune Blvd
Shiloh, IL 62269
1170 Fortune Blvd
Shiloh, IL 62269
Phone (205) 246-5690
6 Park Pl
Swansea, IL 62226
Phone (618) 233-0522
Interoperability endpoints
- blake.ferry.1@21608.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 209.031440 | IL | Yes |
Addresses
Primary practice location
1170 Fortune Blvd
Shiloh, IL 62269-7358
Mailing address
12 Orchard Dr
Charleston, IL 61920-3349
Phone (217) 549-8740
Other providers in Shiloh, IL
- English and McLaughlin, P.C.
- Lindsey Nicole Erickson
- Kelly S Evans
- Sheila Michelle Faszold
- Jennifer Feder
- Alexandra Elizabeth Finley
- Lauren Taylor Flint
- Shannon Lynn Franco
- Kharynn Friesland
- Danielle Lynn Frueh
All providers in Shiloh, IL · Advanced Practice Midwife in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 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.