Active NPI
Blake Holl
- Medical Physician Assistant
- Bronx, NY
National Provider Identifier
1508295486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 017122
- Practice address
- 111 E 210TH St
Bronx, NY 10467-2401 - Phone
- (718) 920-8440
- NPI assigned
- Nov 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 017122 | NY | Primary |
Addresses
Primary practice location
111 E 210TH St
Bronx, NY 10467-2401
Mailing address
111 E 210TH St
Bronx, NY 10467-2401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017122 | NY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Current | Accepting new patients | |
| New York University | Current | Accepting new patients | |
| Montefiore Medical Center | Current | Accepting new patients | |
| New York University | Current | Accepting new patients | |
| Montefiore Medical Center | Past | Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
Interoperability endpoints
- bholl227798@nyumc.direct-ci.com
Organizations & group practices 5
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.
-
- Anesthesiology Physician
- Bronx, NY
- NPI 1063525152
-
- Community/Retail Pharmacy
- Bronx, NY
- NPI 1194183715
-
- Family Medicine Physician
- New York, NY
- NPI 1760288278
-
- Physical Medicine & Rehabilitation Physician
- Boynton Beach, FL
- NPI 1104787613
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1508295486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401",
"telephone_number": "718-920-8440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLL",
"first_name": "BLAKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-01",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "017122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; 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.