Donnevan Blake, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

52766-20 Issued in WI

Practice address

744 S Webster Ave FL 2
Green Bay, WI 54301-3505

Phone

(920) 433-3640

Fax

(920) 433-3716

NPI assigned

May 2, 2006

Last updated

Jul 7, 2011By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, MI2 enrollments

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 2

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

University of Cincinnati College of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oconto Hospital and Medical Center IncGroup PAC ID 2163461781, 217 clinicians

St Francis HospitalGroup PAC ID 5991604753, 85 clinicians

Bellin Memorial Hospital IncGroup PAC ID 8820900749, shared by 10 NPIs, 685 clinicians

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049
• Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358
• Osf St Francis Hospital and Medical Group Hospital, Escanaba, MI, CCN 231337
• Holy Family Memorial Hospital, Manitowoc, WI, CCN 520107
• Bellin Health Oconto Hospital Hospital, Oconto, WI, CCN 521356

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dblake33099@direct.thedacare.org
• Direct secure messaging: dblake916997@direct.emplifyhealth.org

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.

• Oconto Hospital & Medical Center Inc

  dba Emplify Health Oconto Hospital

  • Critical Access Hospital
  • Oconto, WI
  • NPI 1356373302
  Medicare reassignment Care Compare group NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527

  WI

  Medicare reassignment Care Compare group NPD
• St. Francis Hospital

  dba OFSMG - Women's Center

  • Obstetrics & Gynecology Physician
  • Escanaba, MI
  • NPI 1700828837
  Medicare reassignment Care Compare group NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment NPD
• Froedtert Manitowoc Medical Group, LLC

  dba Froedtert Northeast Medical Group

  • Multi-Specialty Clinic/Center
  • Manitowoc, WI
  • NPI 1437829975
  Medicare reassignment NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health Heart & Vascular Crystal Falls

  • Cardiovascular Disease Physician
  • Crystal Falls, MI
  • NPI 1376649509
  Medicare reassignment NPD
• Bellin Memorial Hospital Inc

  dba Neurology Consultants of Bellin Health

  • Neurology Physician
  • Green Bay, WI
  • NPI 1225420664
  NPD
• Oconto Hospital & Medical Center Inc

  dba Bellin Health Suring

  • Rural Health Clinic/Center
  • Suring, WI
  • NPI 1104418037
  NPD
• Oconto Hospital & Medical Center, Inc.

  dba Bellin Health Crivitz

  • Rural Health Clinic/Center
  • Crivitz, WI
  • NPI 1174971725
  NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health Physical Therapy Iron Mountain

  • Physical Therapist
  • Iron Mountain, MI
  • NPI 1699225672
  NPD
• St Francis Hospital

  dba St. Francis Professional Services

  • Anatomic Pathology & Clinical Pathology Physician
  • Escanaba, MI
  • NPI 1932206455
  NPD
• St. Francis Hospital

  dba OSFMG Escanaba Gladstone Powers

  • Family Medicine Physician
  • Escanaba, MI
  • NPI 1629011622
  NPD

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

• Bellin Memorial Hospital Inc.

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1891740585
  Care Compare affiliation
• Door County Memorial Hospital

  dba Door County Medical Center

  • Critical Access Hospital
  • Sturgeon Bay, WI
  • NPI 1093743874
  Care Compare affiliation
• Door County Memorial Hospital

  dba Door County Medical Center Lab

  • Clinical Medical Laboratory
  • Sturgeon Bay, WI
  • NPI 1811090285

  Hospital

  Care Compare affiliation
• Holy Family Memorial Inc

  dba Froedtert Holy Family Memorial Hospital

  • General Acute Care Hospital
  • Manitowoc, WI
  • NPI 1700998697
  Care Compare affiliation
• Oconto Hospital & Medical Center Inc

  dba Emplify Health Oconto Hospital

  • Critical Access Hospital
  • Oconto, WI
  • NPI 1356373302
  Care Compare affiliation
• St Francis Hospital

  dba OSF Healthcare St. Francis Hospital & Medical Group

  • Critical Access Hospital
  • Escanaba, MI
  • NPI 1922058551
  Care Compare affiliation

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1801854898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE FL 2",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-3640",
            "fax_number": "920-433-3716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE FL 2",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-3640",
            "fax_number": "920-433-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "DONNEVAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "52766-20",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301095491",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan G Bisson, CRNA
• Hannah Elizabeth Bitter
• Lesley J Bitters, RN
• Steven Victor Bittorf, MD, PHD
• Robert W Bjoraker Jr., MD
• Maribeth Blake, M.S.CCC-SLP
• Shawn Thornton Blakley, MSE, CADCIII
• Michael Anotonio Blalock, MD
• Vanessa Blanchette, LCSW
• Kaeley Rae Blaney

• Cardiovascular Disease Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Cardiovascular Disease Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; 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.