Kimberly A Blake, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F302529 Issued in NY

Practice address

106 Calvert St
Harrison, NY 10528-3131

Phone

(914) 835-0073

Fax

(914) 835-1071

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

No

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572

  NY

  Medicare reassignment Care Compare group NPD
• The New York and Presbyterian Hospital

  • Nutritionist
  • New York, NY
  • NPI 1891857025

  NY

  Medicare reassignment NPD
• The New York and Presbyterian Hosp

  • Neurology Physician
  • White Plains, NY
  • NPI 1063683068
  NPD
• The New York and Presbyterian Hospital

  • Community/Retail Pharmacy
  • White Plains, NY
  • NPI 1457057226
  NPD
• Optum Medical Care, P.C.

  • Cardiovascular Disease Physician
  • Mount Kisco, NY
  • NPI 1982643003
  NPD (past)
• Park Avenue Medical Associates, P.C.

  • Geriatric Medicine (Family Medicine) Physician
  • White Plains, NY
  • NPI 1730138645
  NPD (past)
• Absolute Outcomes, LLC

  • Internal Medicine Physician
  • Monroe, CT
  • NPI 1073746202
  NPD (past)

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

• Phelps Memorial Hospital Association

  • General Acute Care Hospital
  • Sleepy Hollow, NY
  • NPI 1720185267

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PC 6,374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Phelps Hospital Hospital, Sleepy Hollow, NY, CCN 330261

Medicare fee-for-service enrollment

Enrolled in NY, CT2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles (7 of 11)

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: kimberlyblake@nslijmedgr.allscriptsdirect.net
• Direct secure messaging: kblake61180@northwell.direct-ci.com

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579564800000",
    "number": "1689626319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 CALVERT ST",
            "city": "HARRISON",
            "state": "NY",
            "postal_code": "105283131",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 CALVERT ST",
            "city": "HARRISON",
            "state": "NY",
            "postal_code": "105283131",
            "telephone_number": "914-835-0073",
            "fax_number": "914-835-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F302529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0667910001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02073710",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Berlis
• Michelle Bernardo
• Elyse Beyer, MSW
• Lina Bianco, LCSWR CASAC
• Priya Bibb
• Freyda M Blaustein, P.T.
• Karin Blecher Paz, MD
• Kelly Bonet, PT, DPT, CSCS
• Gennaro R Bonfiglio, MS, LAT, ATC
• Devon L Bonnemere, LCSW

• All providers in Harrison, NY
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.
• 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.