Lara Blake
Individual provider Active NPI Family Medicine Physician · Tupelo, MS
NPI 1881472371 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1881472371
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 906281 (MS)
- Practice address
- 845 S Madison St
Tupelo, MS 38801-4905 - Phone
- (662) 377-3000
- NPI assigned
- Sep 18, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Mississippi Medical Clinics Inc
Practice addresses (Care Compare)
845 S Madison
Tupelo, MS 38801-4905
Phone (601) 790-5025
Hospital & facility affiliations
- North Mississippi Medical Ctr HHA
- North Mississippi Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231103001107 | MS | Practitioner - Nurse Practitioner | 8729435359 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Mississippi Medical Clinics Inc | Current |
Accepting new patients | |
| North Mississippi Medical Center | Current | Accepting new patients | |
| North Mississippi Medical Clinics Inc | Family Medicine | Current |
Accepting new patients |
Locations
808 Varsity Dr
Tupelo, MS 38801
Phone (662) 377-2386
1040A S Madison St
Tupelo, MS 38801
Phone (662) 842-2170
845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025
Interoperability endpoints
- larablake@nmhs.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 906281 | MS | Yes |
Addresses
Primary practice location
845 S Madison St
Tupelo, MS 38801-4905
Mailing address
2056 New Chapel Rd
Nettleton, MS 38858-8257
Phone (662) 538-8753
Other providers in Tupelo, MS
- Bridget Bishop
- Black Sheep Counseling, LLC
- Amanda Blackmon
- James Edwin Blackmon
- Britney Dodson Blackwell
- John Maloney Blakey
- Sandra Blanch
- Inez Blanchard
- Pattie Lavell Blanchard
- Sylvia Blanchard
All providers in Tupelo, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.