Mary L Blake Reeves

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

068911 Issued in MO

Practice address

4626 Lee Ave
Saint Louis, MO 63115-2431

Phone

(314) 385-7726

NPI assigned

May 10, 2006

Last updated

Sep 19, 2011By 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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Saint Louis Connectcare

  dba St. Louis ConnectCare Endoscopy Center

  • Endoscopy Clinic/Center
  • Saint Louis, MO
  • NPI 1679797237
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316390400000",
    "number": "1710937073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 DELMAR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631123005",
            "telephone_number": "314-879-6300",
            "fax_number": "314-879-6372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 LEE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631152431",
            "telephone_number": "314-385-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE REEVES",
        "first_name": "MARY",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "068911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11646789",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427399902",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER IDENTIFIER",
            "identifier": "1710937073",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "815032931",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Jo Blair, M.D.
• Simara N Blair, LMFT
• Stacey Leigh Blair, DC
• Wesley M Blair, MD
• Yolande P Blaise, M.D.
• Jacquelyn Nikol Blake, LPN
• Jane Ann Blake, R.PH.
• Ricky N Blake
• Madeline Blakeley
• Adrianne Blakemore, CD

• Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; 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.