Active NPI
Blake Johnson, MPAS, PA-C
- Surgical Physician Assistant
- Denver, CO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 777 Bannock St
Denver, CO 80204-4507 - Phone
- (303) 436-6000
- NPI assigned
- Apr 30, 2022
- Last updated
- Sep 11, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | NU | Primary | |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
777 Bannock St
Denver, CO 80204-4507
Mailing address
475 N Redwood Rd Unit 16
Salt Lake City, UT 84116-3565
Phone (801) 584-9449
Other practice location 1
475 N Redwood Rd Unit 16
Salt Lake City, UT 84116-3565
Phone (801) 584-9449
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Utah School of Medicine, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
777 Bannock St
Denver, CO 80204-4507
Phone (303) 436-6000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Denver Health and Hospital Authority | Current | Accepting new patients | |
| Denver Health and Hospital Authority | Current | Accepting new patients | |
| Denver Health and Hospital Authority | Past | Accepting new patients |
Locations
777 Bannock St
Denver, CO 80204
777 Bannock St
#1923
Denver, CO 80204
Phone (303) 602-2720
Interoperability endpoints
- bjohnson301619@direct.dhha.org
Organizations & group practices 3
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.
-
- General Practice Physician
- Denver, CO
- NPI 1477569838
-
- Psychiatric Hospital Unit
- Denver, CO
- NPI 1689624942
-
dba Wellington E. Webb Center for Primary Care
- Federally Qualified Health Center (FQHC)
- Denver, CO
- NPI 1922049014
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Denver Health East Grand Community Clinic & Emergency Center
- Emergency Care Clinic/Center
- Winter Park, CO
- NPI 1467762435
Hospital
-
- General Acute Care Hospital
- Denver, CO
- NPI 1689624686
-
- Psychiatric Hospital Unit
- Denver, CO
- NPI 1689624942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1851036214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 N REDWOOD RD UNIT 16",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841163565",
"telephone_number": "801-584-9449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 BANNOCK ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802044507",
"telephone_number": "303-436-6000"
}
],
"practiceLocations": [
{
"address_1": "475 N Redwood Rd Unit 16",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "841163565",
"country_code": "US",
"telephone_number": "801-584-9449",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "BLAKE",
"credential": "MPAS, PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-30",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.