Jack D Blaine, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

D0004502 Issued in MD

Practice address

4400 E West Hwy
Suite 225
Bethesda, MD 20814-4524

Phone

(301) 983-4493

Fax

(301) 983-9379

NPI assigned

Jan 14, 2007

Sex

Male

Sole proprietor

Yes

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 DC

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

Specialty

Psychiatry

Education

Albert Einstein College of Medicine of Yeshiva University, 1968

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720139199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10821 LARKMEADE LN",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208542704",
            "telephone_number": "301-983-4493",
            "fax_number": "301-983-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 E WEST HWY",
            "address_2": "SUITE 225",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208144524",
            "telephone_number": "301-983-4493",
            "fax_number": "301-983-9379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAINE",
        "first_name": "JACK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0004502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Delceta Black, PT
• Karen Leigh Blackburn, M.D.
• Katrina Lynn Blacker, FNP-BC
• Linda Ellen Blackman, L,C.S.W.-C
• Delphine Marie Blain, SC.M., M.B.A
• Jeffrey Abraham Blair, M.D.
• Jessica Anne Blake Hawke, LCSW-C
• Arianna Blake
• Elizabeth Blake, D.O.
• Gregory Blake, MD

• Psychiatry Physician in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.