Patrick W Blake, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A130951 Issued in CA

Practice address

501 Washington St
Suite 502
San Diego, CA 92103-2231

Phone

(619) 542-0013

NPI assigned

Mar 25, 2010

Last updated

Jan 18, 2017By 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 CA

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

Specialty

Dermatology

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medderm CorporationGroup PAC ID 2567465487, 6 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: patrickblake@medderm.ssdirect.aprima.com
• Direct secure messaging: pblake28414@scrippshlth.medalliesdirect.net

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.

• Medderm Corporation

  dba Medderm Associates

  • Dermatology Physician
  • San Diego, CA
  • NPI 1063447936
  Medicare reassignment Care Compare group NPD
• Scripps Health

  dba Scripps Hospital Medical Services

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD
• Katrina E Woodhall, MD and Associates, a Professional Medical

  • Dermatology Physician
  • San Diego, CA
  • NPI 1043528177
  NPD (past)
• Palomar Health

  dba Palomar Medical Center Escondido

  • General Acute Care Hospital
  • Escondido, CA
  • NPI 1457321317
  NPD (past)
• Scripps Health

  • Clinical Medical Laboratory
  • La Jolla, CA
  • NPI 1427034990
  NPD (past)
• Scripps Health

  dba Scripps Memorial Hospital La Jolla

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841277704
  NPD (past)

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1871817312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 WASHINGTON ST",
            "address_2": "SUITE 502",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032231",
            "telephone_number": "619-542-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 WASHINGTON ST",
            "address_2": "SUITE 502",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032231",
            "telephone_number": "619-542-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "PATRICK",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-25",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A130951",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "P3510",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise M Blake, L.AC.
• Gary David Blake, M.D.
• Matthew Alexander Blake, IDC
• Nathan Blake, PPS
• Patricia Blake, L.AC
• Robert E Blake
• Ryan Matthew Blake, MD
• Sissela S Blake, M.D.
• Sheila Louise Blakeley
• Bruce Blakely, D.C.

• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.