John A Blake, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103290NC Issued in NC

Practice address

712 Village Rd SW Ste 104
Shallotte, NC 28470-3449

Phone

(910) 754-7607

Fax

(910) 754-7608

NPI assigned

Feb 12, 2007

Last updated

Jun 3, 2019By 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 NC

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

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbus Family Medical PAGroup PAC ID 2769568492, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Brunswick Medical Center Hospital, Supply, NC, CCN 340158

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: blake.john.007.0330214@cfm.meditab.direct-ci.com

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.

• Columbus Family Medical PA

  dba Brunswick Family Medical

  • Family Medicine Physician
  • Shallotte, NC
  • NPI 1114028859
  Medicare reassignment Care Compare group
• Community Support Agency, LLC

  • Community/Behavioral Health Agency
  • Delco, NC
  • NPI 1447393020
  Medicare reassignment
• Blake Family Medicine PLLC

  • Family Medicine Physician
  • Shallotte, NC
  • NPI 1295959310

  Physician Assistant

  NPD (past) Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Brunswick Community Hospital, LLC

  dba Novant Health Brunswick Medical Center

  • General Acute Care Hospital
  • Bolivia, NC
  • NPI 1710915756
  Care Compare affiliation

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1780726570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 VILLAGE RD SW STE 104",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284703449",
            "telephone_number": "910-754-7607",
            "fax_number": "910-754-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 VILLAGE RD SW STE 104",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284703449",
            "telephone_number": "910-754-7607",
            "fax_number": "910-754-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103290NC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benchmark Physical Therapy of NC, LLC
• Emily Benoit
• Victoria Lynne Bernero, PT, DPT
• Nevaeh Bethea
• Blake Family Medicine PLLC
• Blue Ridge Health and Spine, PLLC (Family First Health Center)
• Morgan Frances Bobb, DPT, PT
• Joan Sebastian Bolanos Lopez, PA-C
• Carly R Booth, MSW LCAS
• Benjamin Houston Bowden, MSN FNP-C

• Physician Assistant in Shallotte, NC
• Providers in Shallotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.
• 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.