Andre Anthony Blake, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA16708 Issued in CA

Practice address

2 W Fern Ave
Redlands, CA 92373-5916

Phone

(909) 793-3311

Fax

(909) 335-4190

NPI assigned

Oct 31, 2005

Last updated

Feb 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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 CA

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Beaver Medical Group P C

  dba Optum

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319
  Medicare reassignment NPD
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• Beaver Medical Group P C

  dba Beaver Advantage Health Center

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1275570830
  NPD (past)
• Redlands Community Hospital

  • General Acute Care Hospital
  • Redlands, CA
  • NPI 1043354111
  NPD (past)

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1588655682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10069",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924230069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W FERN AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735916",
            "telephone_number": "909-793-3311",
            "fax_number": "909-335-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ANDRE",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA16708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Carleigh Bishop
• Rebbecca Lynn Bishop, CMT
• Jessica Lauren Black, RDH
• Janee Blackburn
• Amy Blackmon, MD
• Lindsy Blake, MSW
• Patricia Blakely, M.D.
• Terry Anne Blanchard, BSN, RN
• Blessed Garden Home Corp (Blessed Garden Home Care)
• Camille Tina Block, LVN

• Surgical Physician Assistant in Redlands, CA
• Providers in Redlands, CA by specialty
• Surgical Physician Assistant in California

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