Trent Alton Blake, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4298 Issued in AZ

Practice address

1489 S Higley Rd
Ste 101
Gilbert, AZ 85296-4776

Phone

(480) 457-8800

Fax

(480) 457-8885

NPI assigned

Jun 16, 2006

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 AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Complete Care Medicine Inc

  • Primary Care Clinic/Center
  • Gilbert, AZ
  • NPI 1508023813
  NPD

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1841234010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1489 S HIGLEY RD",
            "address_2": "STE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964776",
            "telephone_number": "480-457-8800",
            "fax_number": "480-457-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1489 S HIGLEY RD",
            "address_2": "STE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964776",
            "telephone_number": "480-457-8800",
            "fax_number": "480-457-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "TRENT",
        "middle_name": "ALTON",
        "name_prefix": "Mr.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "0661",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BKH Health Services, LLC
• Susan Blackburn-Love, LMSW
• Daniel Blackwell
• Blair T Butterfield, PC (Options Medical)
• David Joe Blair
• Amy T. Blanchard, NP
• Bret Egbert Blanchard, PHARM D
• Deydamia Ester Blanco Navas
• Daniel Blanco, O.D.
• Sarah Blankenheimer, FNP-C

• Physician Assistant in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.