Suzzane Marie Blake, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

J9976 Issued in TX

Practice address

4188 NW Loop
Carthage, TX 75633-2255

Phone

(903) 315-4160

Fax

(903) 690-0801

NPI assigned

Jul 27, 2006

Last updated

Aug 1, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sblake149466@christushealth.direct-ci.net

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.

• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Mother Frances Hospital Jacksonville

  dba CHRISTUS Mother Frances Hospital - Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672
  Medicare reassignment NPD
• Mother Frances Hospital Regional Health Care Center

  dba Christus Mother Frances Hospital Tyler

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• East Texas Border Health Clinic

  dba Genesis Primecare

  • Federally Qualified Health Center (FQHC)
  • Texarkana, TX
  • NPI 1598366718

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1689698946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4188 NW LOOP",
            "city": "CARTHAGE",
            "state": "TX",
            "postal_code": "756332255",
            "telephone_number": "903-315-4160",
            "fax_number": "903-690-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4188 NW LOOP",
            "city": "CARTHAGE",
            "state": "TX",
            "postal_code": "756332255",
            "telephone_number": "903-315-4160",
            "fax_number": "903-690-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SUZZANE",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J9976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD5815",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Deann Beamon, LVN
• Belinda M. Beck
• Beckville Independent School District (Panola County SSA)
• Christena Kay Berry
• Bethany Home Health of Longview, LP (Bethany Home Health Services)
• Samuel Dwain Born
• Clayton H. Brakeville, M.S.P.T.
• Brookshire Brothers Inc (Brookshire Brothers Pharmacy)
• Denecia Brown
• Elizabeth Ann Brown, DNP

• Family Medicine Physician in Carthage, TX
• Providers in Carthage, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; 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.