Individual provider Active NPI

Jacob Colman Blakeman, DPM

  • Foot & Ankle Surgery Podiatrist
  • Leesville, LA
National Provider Identifier
1760749261
Registry record updated Dec 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
300191 Issued in LA
Practice address
506 S 6TH St
Leesville, LA 71446-4482
Phone
(337) 239-0989
Fax
(337) 239-0987
NPI assigned
Apr 20, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 300191 LA Primary

Addresses

Primary practice location

506 S 6TH St
Leesville, LA 71446-4482

Mailing address

172 Lonesome Hill Rd
Leesville, LA 71446-6231
Phone (217) 717-7836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180220000537 IL Practitioner - Podiatry 1052613122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Ahs Il Medical Group LLCGroup PAC ID 5496111676, 46 clinicians

Practice addresses (Care Compare)

3908 Maryville Rd
Suite 4
Granite City, IL 62040-4197
Phone (618) 931-3338

Hospital & facility affiliations

  • Gateway Regional Medical Center Hospital, Granite City, IL, CCN 140125

Merit-based Incentive Payment System (MIPS)

Final score
78.11 of 100Reported as individual
Quality
51.58
Promoting interoperability
98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue53
Removal of skin lesions1-10
Removal of nail tissue16

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ahs Il Medical Group LLC CurrentSince Oct 8, 2023 Accepting new patients
Granite City Physicians Corp Past Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

12 Ginger Creek Pkwy
Glen Carbon, IL 62034
Phone (618) 656-8200

4802 S State Route 159
Glen Carbon, IL 62034
Phone 61828843883331

2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000

2044 Madison Ave
Ste 25
Granite City, IL 62040
Phone (618) 239-0678

3908 Maryville Rd
Ste 4
Granite City, IL 62040
Phone (618) 288-6870

2100 Madison Ave
Ste 201
Granite City, IL 62040
Phone (618) 798-8400

2044 Madison Ave
Ste 27
Granite City, IL 62040
Phone (618) 451-0700

2100 Madison Ave
Ste 301
Granite City, IL 62040

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

Interoperability endpoints

  • Direct secure messaging: jcblakem@yourcarecommunity.org
  • Direct secure messaging: jacob.blakeman.1@28328.direct.athenahealth.com

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 5

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": "1334880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449446400000",
    "number": "1760749261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 LONESOME HILL RD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714466231",
            "telephone_number": "217-717-7836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 S 6TH ST",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464482",
            "telephone_number": "337-239-0989",
            "fax_number": "337-239-0987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKEMAN",
        "first_name": "JACOB",
        "middle_name": "COLMAN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-20",
        "last_updated": "2015-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "LA",
            "license": "300191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.