NPIMap

Individual provider Active NPI

Greg M Blakely, MD

  • Internal Medicine Physician
  • Pinehurst, NC
National Provider Identifier
1962442723
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2005-01362 Issued in NC
Practice address
15 Regional Dr
Pinehurst, NC 28374-8850
Phone
(910) 295-5511
Fax
(910) 255-4382
NPI assigned
Jun 8, 2006
Last updated
Jan 24, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2005-01362 NC Primary

Addresses

Primary practice location

15 Regional Dr
Pinehurst, NC 28374-8850

Mailing address

205 Page Rd
Pinehurst, NC 28374-8798
Phone (910) 295-5511

Other practice location 1

15 Regional Dr
Pinehurst, NC 28374-8850
Phone (910) 255-4400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050914001299 NC Practitioner - Internal Medicine 0143253690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinehurst Medical Clinic IncGroup PAC ID 5991617169, 162 clinicians

Practice addresses (Care Compare)

200 Pavilion Way
Southern Pines, NC 28387-4561
Phone (910) 295-5511

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2005-01362NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Medical Clinic, Inc. Internal Medicine CurrentSince Aug 1, 2005 Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Aug 1, 2005 Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients

Locations

15 Regional Dr
Pinehurst, NC 28374
Phone (910) 255-4400

205 Page Rd
Pinehurst, NC 28374
Phone (910) 295-9211

200 Pavilion Way
Southern Pines, NC 28387
Phone (910) 235-3330

4208 Murdocksville Rd
West End, NC 27376
Phone (910) 235-5900

Interoperability endpoints

  • Direct secure messaging: greg.blakely.1@1215.direct.athenahealth.com
  • Direct secure messaging: gregblakely@phmc.allscriptsdirect.net

Organizations & group practices 3

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516752000000",
    "number": "1962442723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PAGE RD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748798",
            "telephone_number": "910-295-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 REGIONAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748850",
            "telephone_number": "910-295-5511",
            "fax_number": "910-255-4382"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Regional Dr",
            "address_purpose": "LOCATION",
            "city": "Pinehurst",
            "state": "NC",
            "postal_code": "283748850",
            "country_code": "US",
            "telephone_number": "910-255-4400",
            "fax_number": "910-255-4382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKELY",
        "first_name": "GREG",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2018-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2005-01362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.