NPIMap

Individual provider Active NPI

Kelly Ann Blake, PA-C

  • Physician Assistant
  • Allentown, PA
National Provider Identifier
1942487673
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0003708 Issued in MD
Practice address
410 N Krocks Rd
Allentown, PA 18106-9283
Phone
(888) 982-8594
Fax
(888) 982-8594
NPI assigned
Jan 24, 2008
Last updated
Feb 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0003708 MD Primary

Addresses

Primary practice location

410 N Krocks Rd
Allentown, PA 18106-9283

Mailing address

PO Box 159
Barrington, NJ 08007-0159

Other practice location 1

150 Sunnyside Blvd
Plainview, NY 11803-1504
Phone (888) 982-8594

Other practice location 2

2004 Shipley Rd
Wilmington, DE 19803-5248
Phone (888) 982-8594

Other practice location 3

1000 Crawford Pl Ste 240
Mount Laurel, NJ 08054-3965
Phone (888) 982-8594

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, NY, DE4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20191015003065 PA Practitioner - Physician Assistant 0547347924 Reassigns benefits to 1 organization
I20210325001303 NJ Practitioner - Physician Assistant 0547347924 Reassigns benefits to 1 organization
I20230118002988 NY Practitioner - Physician Assistant 0547347924 Reassigns benefits to 1 organization
I20230123002151 DE Practitioner - Physician Assistant 0547347924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Telehealth LLCGroup PAC ID 6608156906, 43 clinicians

Practice addresses (Care Compare)

150 Sunnyside Blvd
Plainview, NY 11803-1504
Phone (888) 982-8594

200 Broadhollow Rd
Suite 207
Melville, NY 11747-4806
Phone (888) 982-8594

2004 Shipley Rd
Wilmington, DE 19803-5248
Phone (888) 982-8594

217 Black Horse Pike
Haddon Heights, NJ 08035-1009
Phone (888) 982-8594

410 N Krocks Rd
Allentown, PA 18106-9283
Phone (888) 982-8594

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1942487673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "BARRINGTON",
            "state": "NJ",
            "postal_code": "080070159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N KROCKS RD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181069283",
            "telephone_number": "888-982-8594",
            "fax_number": "888-982-8594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Sunnyside Blvd",
            "address_purpose": "LOCATION",
            "city": "Plainview",
            "state": "NY",
            "postal_code": "118031504",
            "country_code": "US",
            "telephone_number": "888-982-8594",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2004 Shipley Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "DE",
            "postal_code": "198035248",
            "country_code": "US",
            "telephone_number": "888-982-8594",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Crawford Pl Ste 240",
            "address_purpose": "LOCATION",
            "city": "Mount Laurel",
            "state": "NJ",
            "postal_code": "080543965",
            "country_code": "US",
            "telephone_number": "888-982-8594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-24",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0003708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.