Sally S Blake, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

710 Issued in SC

Practice address

2319 Saint Matthews Rd
Orangeburg, SC 29118

Phone

(803) 536-1571

Fax

(803) 534-3860

NPI assigned

Jan 15, 2007

Last updated

Feb 11, 2019By 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 3

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• South Carolina Dept of Mental Health Accounting Office

  dba Waccamaw Center for Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Conway, SC
  • NPI 1356397228
  Medicare reassignment NPD
• South Carolina Dept of Mental Health Accounting Office

  dba Midlands Crisis Stabilization Center

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1083421994
  NPD
• South Carolina Dept of Mental Health Accounting Office

  dba Orangeburg Area Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Orangeburg, SC
  • NPI 1164457735
  NPD
• E Jackson St Emergency Physicians LLC

  • Emergency Medicine Physician
  • Dillon, SC
  • NPI 1932398773
  NPD (past)
• Robert L Smoak

  dba Robert L Smoak, MD

  • Family Medicine Physician
  • Orangeburg, SC
  • NPI 1669437430
  NPD (past)
• Robert L Smoak

  dba Robert L Smoak MD

  • Rural Health Clinic/Center
  • Orangeburg, SC
  • NPI 1720151483
  NPD (past)
• SC Healthcare Investments, LLC

  dba Southern Palmetto Hospital

  • General Acute Care Hospital
  • Barnwell, SC
  • NPI 1558760256
  NPD (past)

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1750432985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2319 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291182042",
            "telephone_number": "803-536-1571",
            "fax_number": "803-534-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2319 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29118",
            "telephone_number": "803-536-1571",
            "fax_number": "803-534-3860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "86 Wren St",
            "address_purpose": "LOCATION",
            "city": "Barnwell",
            "state": "SC",
            "postal_code": "298121529",
            "country_code": "US",
            "telephone_number": "803-259-5762",
            "fax_number": "803-259-3250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "521 Gibson Rd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "SC",
            "postal_code": "290722551",
            "country_code": "US",
            "telephone_number": "803-951-3490",
            "fax_number": "803-951-3557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SALLY",
        "middle_name": "S",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "710",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1060",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRESCRIPTIVE AUTHORITY",
            "identifier": "F710",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Biologic P and O, LLC
• Black River Labs and Wellness Center
• Black River Labs and Wellness Center
• Black River Labs and Wellness Center
• Matthew Lynn Blackburn, M.D.
• Gerard Kevin Blanchard Sr., LICENSED OPTICIAN
• Kevin L. Blanchard, CRNA
• Laura R Blankenship
• Monica Liliane Blundell Osorio
• Yaw Boateng, R.D., C.D.E.

• Family Nurse Practitioner in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.