Jerome M Blake, MD

Primary specialty

Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X

License

2228 Issued in SD

Practice address

1600 W 22ND St
Sioux Falls, SD 57105-1521

Phone

(605) 312-1000

Fax

(605) 312-1001

NPI assigned

Sep 16, 2005

Last updated

Mar 13, 2015By 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 SD

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

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.

• Sanford Clinic

  dba Sanford Health Psychiatry & Psychology Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254
  Medicare reassignment NPD
• Sanford Clinic

  dba Sanford Children's Specialty Clinic

  • Pediatrics Physician
  • Sioux Falls, SD
  • NPI 1881610889
  NPD
• Sanford Clinic

  dba Sanford Virtual Health Services

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345
  NPD
• University Physician

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1942236096
  NPD (past)

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426204800000",
    "number": "1699760546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-7180",
            "fax_number": "605-328-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051521",
            "telephone_number": "605-312-1000",
            "fax_number": "605-312-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JEROME",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2015-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "SD",
            "license": "2228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerri Bjornson
• Allison Black
• Alexis J Blackwelder, FNP
• Renee L Blaha, PA-C
• Kirsten Rae Blair, MS, OTR/L
• Matthew Blake, M.D.
• Rachel Ann Blake, OTR/L
• Hannah Renae Blankespoor, FNP-C
• Karyl Deann Blaseg, RN
• Keelan Noelle Blasius

• Pediatric Neurodevelopmental Disabilities Physician in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Pediatric Neurodevelopmental Disabilities Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; 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.