NPIMap

Individual provider Active NPI

Blake L Anderson, MD PHD

  • Otolaryngology Physician
  • Tulsa, OK
National Provider Identifier
1962499574
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
L6260 Issued in TX
Practice address
9001 S 101St East Ave Ste 280
Tulsa, OK 74133-5711
Phone
(918) 459-8824
NPI assigned
Sep 29, 2005
Last updated
Jan 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X L6260 TX Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20180926001032 OK Practitioner - Otolaryngology 2466465570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 LLCGroup PAC ID 9436122496, 314 clinicians

Practice addresses (Care Compare)

9001 S 101St E Ave
Suite 280
Tulsa, OK 74133-5711
Phone (918) 392-5411

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ahs Oklahoma Physician Group LLC Otolaryngology CurrentSince Sep 1, 2018 Accepting new patients
Ahs Oklahoma Physician Group, LLC CurrentSince Sep 1, 2018 Accepting new patients
Texas Ear, Nose & Throat Specialists, PLLC Otolaryngology PastSince Aug 15, 2015 Accepting new patients
Karen L Stierman, MD PA PastSince Apr 1, 2003 Accepting new patients
Noble Anesthesia Partners, PLLC Past Accepting new patients
Ahs Southcrest Hospital, LLC Past Accepting new patients
Ahs Pryor Hospital, LLC 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

1145 S Utica Ave
Ste 110
Tulsa, OK 74104
Phone (918) 579-3825

9001 S 101st East Ave
Ste 280
Tulsa, OK 74133
Phone (918) 392-5411

Dept 1206
Tulsa, OK 74182

Interoperability endpoints

  • Direct secure messaging: banderson174786@ahs.direct-ci.com
  • Direct secure messaging: blake.anderson@direct.mymlc.com
  • FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4

Organizations & group practices 7

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 4

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1962499574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 S UTICA AVE STE 110",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 S 101ST EAST AVE STE 280",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335711",
            "telephone_number": "918-459-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "BLAKE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "L6260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.