Jeffrey Lee Blake, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT17676 Issued in CA

Practice address

1714 17TH St
Santa Monica, CA 90404-4410

Phone

(310) 392-7889

Fax

(310) 314-4431

NPI assigned

Jan 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blake Physical Therapy PCGroup PAC ID 8729974001, 10 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blake Physical Therapy, PC

  • Orthopedic Physical Therapist
  • Santa Monica, CA
  • NPI 1750350476
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1407834781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 17TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044410",
            "telephone_number": "310-392-7889",
            "fax_number": "310-314-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 17TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044410",
            "telephone_number": "310-392-7889",
            "fax_number": "310-314-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JEFFREY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT17676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ05281Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evangeline Bishop, PSY.D.
• Diane Black, L.AC.
• Richard Blackburn
• Janine A Blackman, M.D.
• Blake Physical Therapy, PC
• Melissa Blake, ACSW
• Karen L Blanchard, M.D.
• Alejandra Blanco
• Roseanne Sofia Evangelista Blanco, OTR/L
• Hanna Lorraine Blankemeier, MD

• Physical Therapist in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.