Individual provider Active NPI

Blake Harrison Priddy, M.D.

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1699265892
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11019795A Issued in IN
Practice address
355 W 16TH St Ste 5100
Indianapolis, IN 46202-2274
Phone
(317) 396-1234
NPI assigned
May 14, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11019795A IN Primary
Student in an Organized Health Care Education/Training Program 390200000X 11019795A IN

Addresses

Primary practice location

355 W 16TH St Ste 5100
Indianapolis, IN 46202-2274

Mailing address

355 W 16TH St Ste 5100
Indianapolis, IN 46202-2274
Phone (317) 396-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20210610002946 IN Practitioner - Family PracticePractitioner - Peripheral Vascular Disease 1557626819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Peripheral Vascular Disease
Education
Ohio State University College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vohra Wound Physicians of the West PCGroup PAC ID 5890931331, 17 clinicians

Practice addresses (Care Compare)

118 Medical Dr
Carmel, IN 46032-3323
Phone (877) 866-7123

120 E Miller Dr
Bloomington, IN 47401-6538
Phone (877) 866-7123

140 W Washington St
Morgantown, IN 46160-9547
Phone (317) 597-4418

1701 McDowell Rd
Evansville, IN 47712-5431
Phone (877) 866-7123

2741 N Salisbury St
West Lafayette, IN 47906-1431
Phone (877) 866-7123

3401 Soldiers Home Rd
West Lafayette, IN 47906-1222
Phone (877) 866-7123

5430 W US Hwy 40
Greenfield, IN 46140-8803
Phone (877) 866-7123

725 N Bell Trace Cir
Bloomington, IN 47408-4408
Phone (877) 866-7123

8616 W 10TH St
Indianapolis, IN 46234-2167
Phone (877) 866-7123

868 S Washington St
Morristown, IN 46161-9633
Phone (877) 866-7123

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue414
Removal of skin lesions19
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11019795AINMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Vohra Wound Physicians of the West, P.C. Family Medicine CurrentSince May 31, 2021 Accepting new patients
Major Hospital Past Accepting new patients

Locations

3601 SW 160th Ave
Ste 250
Miramar, FL 33027
Phone (305) 866-9951

9465 Counselors Row
Ste 200
Indianapolis, IN 46240
Phone (463) 220-4646

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1699265892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST STE 5100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022274",
            "telephone_number": "317-396-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W 16TH ST STE 5100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022274",
            "telephone_number": "317-396-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDDY",
        "first_name": "BLAKE",
        "middle_name": "HARRISON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-14",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11019795A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11019795A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.