Blake Ariel Banner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05015177A Issued in IN

Practice address

2950 Donnell Dr Ste G
Forestville, MD 20747-3277

Phone

(240) 492-3410

Fax

(301) 278-9852

NPI assigned

Nov 28, 2018

Last updated

May 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

86.32 of 100Reported as group

Quality

84.44

Promoting interoperability

99

Improvement activities

40

Cost

70.78

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Athletico LTD

  dba Athletico Physical Therapy

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028

  IN

  Medicare reassignment Care Compare group NPD
• Athletic and Therapeutic Institute of Naperville LLC

  dba ATI Physical Therapy

  • Physical Therapist
  • Aurora, IL
  • NPI 1023129681
  Medicare reassignment NPD
• Athletic and Therapeutic Institute of Naperville, LLC

  • Durable Medical Equipment & Medical Supplies
  • Hazel Crest, IL
  • NPI 1043952641
  NPD
• Athletico LTD

  dba Athletico Physical Therapy

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD
• Athletico, LTD

  dba Athletico Physical Therapy

  • Clinic/Center
  • Schererville, IN
  • NPI 1689974131

  Physical Therapist

  NPD
• Stafford Hospital, LLC

  dba Stafford Hospital

  • General Acute Care Hospital
  • Stafford, VA
  • NPI 1043343304
  NPD (past)

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

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1942770342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 DONNELL DR STE G",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207473277",
            "telephone_number": "240-492-3410",
            "fax_number": "301-278-9852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Patewood Dr Ste C150",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296156323",
            "country_code": "US",
            "telephone_number": "864-454-0904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2875 Crain Hwy Ste 6",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206012841",
            "country_code": "US",
            "telephone_number": "301-859-3304",
            "fax_number": "301-383-8305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANNER",
        "first_name": "BLAKE",
        "middle_name": "ARIEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-28",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070026352",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "27579",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05015177A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashes Rising Counseling Services LLC
• Zenaida Carlos Asuncion, RPH
• Ati Holding LLC (ATI Physical Therapy)
• Maureen Meyang Ayong
• Floyd Bagwell
• Meikel Barnes
• Basics Counseling Services LLC
• Basics Group Practice LLC
• Basics Group Practice, LLC
• Nichole Blackmon, LPC

• Physical Therapist in Forestville, MD
• Providers in Forestville, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.