John S Blake, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

49109901205 Issued in 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

Last updated

May 2, 2017By the provider in NPPES

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 UT

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

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 GroupGroup PAC ID 2961496609, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uintah Basin Medical Center Hospital, Roosevelt, UT, CCN 460019

Merit-based Incentive Payment System (MIPS)

Final score

89.32 of 100Reported as apm

Quality

71.89

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199
  Medicare reassignment Care Compare group NPD
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment NPD
• Northeastern Utah Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Roosevelt, UT
  • NPI 1740482009
  NPD
• Uintah Basin Medical Center

  dba Uintah Basin Healthcare Vernal Pharmacy

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD

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

• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Care Compare affiliation
• Uintah Basin Medical Center

  dba Uintah Basin Medical Center Vernal

  • General Acute Care Hospital
  • Vernal, UT
  • NPI 1881447571
  Care Compare affiliation
• Uintah Basin Medical Center

  dba UBMC Physical Therapy

  • Physical Therapy Clinic/Center
  • Ballard, UT
  • NPI 1912750662

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493683200000",
    "number": "1508826587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W 300 N 7-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-6104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 300 N 7-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JOHN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2017-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "UT",
            "license": "49109901205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Birch, PHARM.D.
• Madison G Birchell
• Trever Birchell
• Sherry Lynn Bird, TRT
• Lauren Ann Bishop, MD
• Christian Boekweg, DO
• Tanya Sarah Boren, FNP
• Paul W Brinkerhoff, C.P.
• Angala Dee Bryson
• Shirlie Burdick

• MOHS-Micrographic Surgery Physician in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• MOHS-Micrographic Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.