Blake L Anderson, MD PHD
Individual provider Active NPI Otolaryngology Physician · Tulsa, OK
NPI 1962499574 · NPPES record last updated Jan 12, 2021
Key facts
- NPI
- 1962499574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- L6260 (TX)
- Practice address
- 9001 S 101St East Ave Ste 280
Tulsa, OK 74133-5711 - Phone
- (918) 459-8824
- NPI assigned
- Sep 29, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- Columbia University College of Physicians and Surgeons, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ahs Oklahoma Physician Group LLC
Practice addresses (Care Compare)
9001 S 101St E Ave
Suite 280
Tulsa, OK 74133-5711
Phone (918) 392-5411
Hospital & facility affiliations
- Hillcrest Hospital South
- Hillcrest Medical Center
- Hillcrest Hospital Pryor
- Hillcrest Hospital Cushing
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180926001032 | OK | Practitioner - Otolaryngology | 2466465570 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L6260 | TX | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ahs Oklahoma Physician Group, LLC | Current |
Accepting new patients | |
| Ahs Oklahoma Physician Group LLC | Otolaryngology | Current |
Accepting new patients |
| Ahs Southcrest Hospital, LLC | Past | Accepting new patients | |
| Noble Anesthesia Partners, PLLC | Past | Accepting new patients | |
| Ahs Pryor Hospital, LLC | Past | Accepting new patients | |
| Texas Ear, Nose & Throat Specialists, PLLC | Otolaryngology | Past |
Accepting new patients |
| Karen L Stierman, MD PA | Past |
Accepting new patients |
Locations
1301 NE 1st St
Ste 100
Pryor, OK 74361
Phone (918) 392-0175
20 E 34th St
Sand Springs, OK 74063
Phone (918) 245-9675
Dept 1206
Tulsa, OK 74182
9001 S 101st East Ave
Ste 280
Tulsa, OK 74133
Phone (918) 392-5411
1145 S Utica Ave
Ste 110
Tulsa, OK 74104
Phone (918) 579-3825
Interoperability endpoints
- banderson174786@ahs.direct-ci.com
- blake.anderson@direct.mymlc.com
- https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | L6260 | TX | Yes |
Addresses
Primary practice location
9001 S 101St East Ave Ste 280
Tulsa, OK 74133-5711
Mailing address
1145 S Utica Ave Ste 110
Tulsa, OK 74104-4013
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1459097 | Other | TX | BEECHSTREET |
| 157856901 | Medicaid | TX |
Other providers in Tulsa, OK
- Alison Anderson
- Andre Anderson
- Andria Lenay Anderson
- Ben Anderson
- Benjamin Coleman Anderson
- Brenda Kay Anderson
- Brett Michael Anderson
- Brianna Anderson
- Bridget Anderson
- Brooke Anne Anderson
All providers in Tulsa, OK · Otolaryngology Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2021. 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.