Blake Andrew Wylie, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A11088 Issued in CA

Practice address

23181 Verdugo Dr Ste 103a
Laguna Hills, CA 92653-1313

Phone

(949) 366-1053

NPI assigned

Aug 25, 2010

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 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

Family Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, 291 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• JTC Home Health Inc Home health agency, San Diego, CA, CCN 757351

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: bwylie18854@syhealth.direct-ci.com

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.

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Precision Park

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment Care Compare group NPD
• Housecall Doctors Medical Group Inc

  • Geriatric Medicine (Family Medicine) Physician
  • Long Beach, CA
  • NPI 1033164017
  Medicare reassignment NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  dba San Ysidro Health Senior Dental Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health San Ysidro Health Center

  • Federally Qualified Health Center (FQHC)
  • San Ysidro, CA
  • NPI 1952364747
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health National City

  • Federally Qualified Health Center (FQHC)
  • National City, CA
  • NPI 1003869363
  NPD (past)
• Rady Children's Hospital San Diego

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Diego, CA
  • NPI 1851303994
  NPD (past)

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

• JTC Home Health, Inc.

  • Home Health Agency
  • San Diego, CA
  • NPI 1295306991
  Care Compare affiliation

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

{
    "created_epoch": "1282694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1922314145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2721 WASHINGTON STREET",
            "city": "JULIAN",
            "state": "CA",
            "postal_code": "92036",
            "telephone_number": "760-765-1223",
            "fax_number": "760-765-1278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23181 VERDUGO DR STE 103A",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531313",
            "telephone_number": "949-366-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLIE",
        "first_name": "BLAKE",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-25",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A11088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wyatt Austin Foster Woodward
• Wound Physicians of California PC
• Allison Nichole Wright, PA-C
• E Clark Wright, D.D.S., M.S.ED.
• George Renchao Wu, DO
• Xianan Li Chiropractic Professional Corporation (Li Chiropractic & Wellness)
• Xiaoman Yang (Hao Acupuncture)
• Aline Yaghsezian, DDS
• Yanbing Zeng MD Inc
• Yang Yang Yu D.M.D, Inc (Elite Dental Group)

• Family Medicine Physician in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.