Jeffrey M Blake, MD

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

License

01040057A Issued in IN

Practice address

14540 Prairie Lakes Blvd N Ste 110
Noblesville, IN 46060-4370

Phone

(317) 982-5222

Fax

(317) 982-5223

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Indiana University School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Hospital, Indianapolis, IN, CCN 150056
• Community Hospital of Anderson and Madison County Hospital, Anderson, IN, CCN 150113

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jmblakemd@advancedgynin.emadirect.md

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.

• Advanced Gynecology & Pelvic Health Specialists, LLC

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Noblesville, IN
  • NPI 1265202105

  IN, Urogynecology and Reconstructive Pelvic Surgery

  Medicare reassignment NPD Authorized official
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Hospital of Anderson & Madison County, Inc

  • General Acute Care Hospital
  • Anderson, IN
  • NPI 1972500452

  Hospital

  Care Compare affiliation
• Indiana University Health Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1144266024

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1477545127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14540 PRAIRIE LAKES BLVD N STE 110",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460604370",
            "telephone_number": "317-982-5222",
            "fax_number": "317-982-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 PRAIRIE LAKES BLVD N STE 110",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460604370",
            "telephone_number": "317-982-5222",
            "fax_number": "317-982-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IN",
            "license": "01040057A",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "IN",
            "license": "01040057A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300085297",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100172960",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Bird
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• Gary Robert Blackburn
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• Brenda June Bleyle
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• Staci Jean Blume, D.C.
• BMK Home Services LLC
• Maria Boehm, RN

• All providers in Noblesville, IN
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.