Individual provider Active NPI

Peter Blakemore, DO

  • Neuromusculoskeletal Medicine & OMM Physician
  • East Lansing, MI
National Provider Identifier
1821251208
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X
License
5101018477 Issued in MI
Practice address
4660 S Hagadorn Rd Ste 500
East Lansing, MI 48823-6804
Phone
(517) 432-6144
Fax
(517) 432-6150
NPI assigned
Jul 7, 2008
Last updated
Jun 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 5101018477 MI Primary

Addresses

Primary practice location

4660 S Hagadorn Rd Ste 500
East Lansing, MI 48823-6804

Mailing address

804 Service Rd Ste A109B
East Lansing, MI 48824-7015
Phone (517) 432-6144

Other identifiers 1

IdentifierTypeStateIssuer
1821251208MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110812000147 MI Practitioner - Osteopathic Manipulative Medicine 7810166618 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Osteopathic Manipulative Medicine
Education
University of New England, College of Osteo Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

4660 S Hagadorn Rd
Suite 500
East Lansing, MI 48823-6804
Phone (517) 432-6144

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101018477MIMDNeuromusculoskeletal Medicine & OMM Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Msu Health Care Inc Neuromusculoskeletal Medicine & Omm CurrentSince Jul 1, 2020 Accepting new patients
Michigan State University CurrentSince Jul 1, 2011 Accepting new patients
Msu Health Care Inc. CurrentSince Jul 1, 2020 Accepting new patients
Michigan State University CurrentSince Jul 1, 2011 Accepting new patients
Msu Health Care Inc Current Accepting new patients
Michigan State University Current Accepting new patients

Locations

4660 S Hagadorn Rd
Ste 420
East Lansing, MI 48823
Phone (517) 884-6100

4660 S Hagadorn Rd
Ste 500
East Lansing, MI 48823
Phone (517) 432-6144

804 Service Rd
Ste A109B
East Lansing, MI 48824
Phone (517) 884-2976

1200 E Michigan Ave
Ste 655
Lansing, MI 48912
Phone (517) 267-2460

Interoperability endpoints

  • Direct secure messaging: peter.blakemore.1@25394.direct.athenahealth.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1821251208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-432-6144",
            "fax_number": "517-432-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S HAGADORN RD STE 500",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488236804",
            "telephone_number": "517-432-6144",
            "fax_number": "517-432-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKEMORE",
        "first_name": "PETER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MI",
            "license": "5101018477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821251208",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.