John S Blake, MD
Individual provider Active NPI MOHS-Micrographic Surgery Physician · Roosevelt, UT
NPI 1508826587 · NPPES record last updated May 2, 2017
Key facts
- NPI
- 1508826587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- MOHS-Micrographic Surgery Physician 207ND0101X
- License
- 49109901205 (UT)
- Practice address
- 210 W 300 N 7-3
Roosevelt, UT 84066 - Phone
- (435) 722-3971
- Fax
- (435) 722-6104
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- University of Utah School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northeastern Utah Medical Group
Practice addresses (Care Compare)
210 W 300
Roosevelt, UT 84066-2336
Phone (435) 722-4691
250 W 300
Roosevelt, UT 84066-2336
405 N 500
Vernal, UT 84078-1907
Phone (435) 789-6203
475 N 500
Vernal, UT 84078-1907
Phone (435) 781-2030
Hospital & facility affiliations
- Uintah Basin Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.32 of 100
- Quality
- 71.89
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 35 |
| Removal of skin lesions | 426 |
| Removal of skin cancer | 219 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 197 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100510000420 | UT | Practitioner - Dermatology | 3173651395 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49109901205 | UT | MD | MOHS-Micrographic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeastern Utah Medical Group | Current |
Accepting new patients | |
| Uintah Basin Medical Center | Current |
Accepting new patients | |
| Uintah Basin Medical Center | Current |
Accepting new patients | |
| Northeastern Utah Medical Group | Current |
Accepting new patients |
Locations
50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426
250 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691
210 W 300 N
#73
Roosevelt, UT 84066
Phone (435) 722-3971
210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691
250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| MOHS-Micrographic Surgery Physician | 207ND0101X | 49109901205 | UT | Yes |
Addresses
Primary practice location
210 W 300 N 7-3
Roosevelt, UT 84066
Mailing address
210 W 300 N 7-3
Roosevelt, UT 84066
Phone (435) 722-3971
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D3948 | Medicaid | UT |
Other providers in Roosevelt, UT
- Madison G Birchell
- Trever Birchell
- Sherry Lynn Bird
- Lauren Ann Bishop
- Kyler Black
- Christian Boekweg
- Tanya Sarah Boren
- Paul W Brinkerhoff
- Angala Dee Bryson
- Shirlie Burdick
All providers in Roosevelt, UT · MOHS-Micrographic Surgery Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2017. 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.