Michael Scott Blakeslee, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

60 Valley Street Clinica Esperanza/Hope Clinic
Suite 104
Providence, RI 02609

Phone

(401) 347-9093

Fax

(401) 633-6949

NPI assigned

Apr 7, 2018

Reactivated

May 8, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1523059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1639676547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 VALLEY STREET CLINICA ESPERANZA/HOPE CLINIC",
            "address_2": "SUITE 104",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02609",
            "telephone_number": "401-347-9093",
            "fax_number": "401-633-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 VALLEY STREET CLINICA ESPERANZA/HOPE CLINIC",
            "address_2": "SUITE 104",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02609",
            "telephone_number": "401-347-9093",
            "fax_number": "401-633-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKESLEE",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-07",
        "last_updated": "2024-05-09",
        "deactivation_date": "2024-04-09",
        "reactivation_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Clark Blaisdell
• Christopher Blake
• Dawna A. Blake, M.D.
• Douglas Blake, MD
• Megan Blake
• Kereth Lynn Blanchard, OT
• Lauren Blanchette, LCSW
• Meghan Blanchette, NP
• Elisy Isabel Blanco Mercado, LICSW
• Christopher Blanco-Ramos, LMHC

• Physician Assistant in Providence, RI
• Providers in Providence, RI by specialty
• Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.