Sal Blake, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TC733 Issued in KY

Practice address

2211 Mayfair Dr Ste 102
Owensboro, KY 42301

Phone

(270) 688-1351

Fax

(270) 683-3420

NPI assigned

Aug 9, 2018

Last updated

May 14, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sblake227638@direct.deaconess.com

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.

• Deaconess Clinic Inc.

  • Internal Medicine Physician
  • Evansville, IN
  • NPI 1619123585
  Medicare reassignment Care Compare group
• Methodist Health, Inc.

  dba Deaconess Henderson Emergency

  • Emergency Medicine Physician
  • Henderson, KY
  • NPI 1912544958

  Physician Assistant

  Medicare reassignment NPD
• Deaconess Hospital, Inc

  dba Deaconess Care Group

  • Hospitalist Physician
  • Evansville, IN
  • NPI 1427097443

  Physician Assistant

  Medicare reassignment NPD (past)
• Acute Care LLC

  dba Urgent Care West

  • Nurse Practitioner
  • Owensboro, KY
  • NPI 1376273755
  Medicare reassignment
• Deaconess Clinic, Inc

  dba Deaconess Clinic I

  • Family Medicine Physician
  • Morganfield, KY
  • NPI 1891941688
  Medicare reassignment
• Deaconess Clinic, Inc

  dba Deaconess Clinic Klutey Park

  • Family Medicine Physician
  • Henderson, KY
  • NPI 1104445014
  NPD
• Methodist Health, Inc.

  dba Deaconess Henderson Pain Services

  • Pain Clinic/Center
  • Henderson, KY
  • NPI 1780249060
  NPD
• Deaconess Clinic Inc

  • Neurology Physician
  • Newburgh, IN
  • NPI 1013558980

  Physician Assistant

  NPD
• Deaconess Clinic Inc

  • Pediatrics Physician
  • Washington, IN
  • NPI 1356132310

  Physician Assistant

  NPD
• Deaconess Hospital Inc

  • Mental Health Counselor
  • Evansville, IN
  • NPI 1508723552
  NPD
• Deaconess Hospital, Inc

  dba Deaconess Emergency Physicians

  • Emergency Medicine Physician
  • Evansville, IN
  • NPI 1922036805

  Physician Assistant

  NPD
• Deaconess Clinic, Inc

  dba Deaconess Clinic I

  • Rural Health Clinic/Center
  • Petersburg, IN
  • NPI 1831345792
  NPD (past)

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

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1962981084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330",
            "fax_number": "270-688-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MAYFAIR DR STE 102",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "42301",
            "telephone_number": "270-688-1351",
            "fax_number": "270-683-3420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 Unifirst Dr",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423017701",
            "country_code": "US",
            "telephone_number": "270-713-0478",
            "fax_number": "270-713-0479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SAL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-09",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100552610",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sblake89950@direct.owensborohealth.org",
            "affiliation": "N",
            "address_1": "2211 Mayfair Dr Ste 102",
            "city": "Owensboro",
            "state": "KY",
            "country_code": "US",
            "postal_code": "42301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamie Bisel, PA-C
• William S Black, MD
• Holly Blackburn, LPCA
• Jack C Blackstone, Jr., M.D.
• Paighten Blades, OTR/L
• H. Dwaine Blakeman, DMD
• Courtney Lynn Blandford, NP
• Jonathan Blandford, DO
• Lee Ann Blandford, SLP
• Nanette Ann Blandford, SPEECH THERAPIST

• Physician Assistant in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.