Michael Anotonio Blalock, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

76147-20 Issued in WI

Practice address

835 S Van Buren St
Green Bay, WI 54301-3575

Phone

(920) 433-0111

NPI assigned

Apr 2, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Anesthesiology

Education

Medical College of Wisconsin, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Green Bay Anesthesia Assoc. SCGroup PAC ID 4486613858, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
• St Vincent Hospital Hospital, Green Bay, WI, CCN 520075

Merit-based Incentive Payment System (MIPS)

Final score

74.22 of 100Reported as group

Quality

69.67

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Green Bay Anesthesia Assoc. SC

  • Anesthesiology Physician
  • Green Bay, WI
  • NPI 1023065836
  Medicare reassignment Care Compare group NPD

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

• St Mary'S Hospital Medical Center of Green Bay Inc.-Hospital Sisters

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1649246877
  Care Compare affiliation
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1114908001
  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • Hematology & Oncology Physician
  • Sheboygan, WI
  • NPI 1831784636

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Green Bay, WI
  • NPI 1184004236

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Oconto Falls, WI
  • NPI 1750760740

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Sturgeon Bay, WI
  • NPI 1760861751

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1881156495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 BROOKWOOD DR APT 312",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044146",
            "telephone_number": "312-217-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S VAN BUREN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013575",
            "telephone_number": "920-433-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "MICHAEL",
        "middle_name": "ANOTONIO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "76147-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Victor Bittorf, MD, PHD
• Robert W Bjoraker Jr., MD
• Donnevan Blake, M.D.
• Maribeth Blake, M.S.CCC-SLP
• Shawn Thornton Blakley, MSE, CADCIII
• Vanessa Blanchette, LCSW
• Kaeley Rae Blaney
• Heidi Blank, M.D.
• Jules H Blank, M.D.
• Heidi Blanks, LPC

• Anesthesiology Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Anesthesiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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.