Blake Wesley Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2000 S Wheeling Ave Ste 900
Tulsa, OK 74104-5647

Phone

(918) 403-6284

Fax

(918) 403-6323

NPI assigned

Nov 11, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bjohnson904314@ahs.direct-ci.com

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.

• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment NPD
• Advanced Wound Therapy

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1922719095
  Medicare reassignment
• Emergency Medicine Physicians of Tulsa County, LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1003098773
  Medicare reassignment
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406
  Medicare reassignment
• Usacs Observation Medicine Services of Oklahoma, LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1326739111
  Medicare reassignment
• St. John Physicians, Inc

  dba Siggins Memorial Clinic

  • Rural Health Clinic/Center
  • Barnsdall, OK
  • NPI 1033176367
  NPD

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

{
    "created_epoch": "1415664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1497151922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S WHEELING AVE STE 900",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045647",
            "telephone_number": "918-403-6284",
            "fax_number": "918-403-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S WHEELING AVE STE 900",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045647",
            "telephone_number": "918-403-6284",
            "fax_number": "918-403-6323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BLAKE",
        "middle_name": "WESLEY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-11",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Michelle Johnson
• Anthony Earl Johnson
• Antonise Johnson, APRN
• Ashley Nicole Johnson
• Austin L Johnson
• Brandi Joy Johnson, PHARMACY TECH
• Brandi Lynn Johnson, O.D.
• Breanne Dawn Johnson
• Brittany Michelle Johnson
• Cardell Johnson

• Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.