NPIMap

Individual provider Active NPI

Blake Allan Peterson

  • Emergency Medicine Physician
  • Buffalo, NY
National Provider Identifier
1790480549
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
343066 Issued in NY
Practice address
955 Main St Ste 7230
Buffalo, NY 14203-1121
Phone
(716) 829-2012
Fax
(716) 829-3999
NPI assigned
Apr 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 343066 NY Primary

Addresses

Primary practice location

955 Main St Ste 7230
Buffalo, NY 14203-1121

Mailing address

955 Main St Ste 7230
Buffalo, NY 14203-1121
Phone (716) 829-2012

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260515003268 NY Practitioner - Emergency Medicine 5395214639

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
State University of New York at Buffalo School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Emergency Medical Services Inc.Group PAC ID 0749182665, 97 clinicians

Practice addresses (Care Compare)

1540 Maple Rd
Williamsville, NY 14221-3647
Phone (716) 568-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

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 10

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": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1790480549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 MAIN ST STE 7230",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031121",
            "telephone_number": "716-829-2012",
            "fax_number": "716-829-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 MAIN ST STE 7230",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031121",
            "telephone_number": "716-829-2012",
            "fax_number": "716-829-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BLAKE",
        "middle_name": "ALLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "343066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.