NPIMap

Individual provider Active NPI

Patricia Blakely, M.D.

  • Nephrology Physician
  • Redlands, CA
National Provider Identifier
1972617413
Registry record updated Dec 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G66318 Issued in CA
Practice address
251 Cajon St
Suite B
Redlands, CA 92373-5260
Phone
(909) 793-7500
Fax
(909) 798-2411
NPI assigned
Aug 19, 2006
Last updated
Dec 2, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X G66318 CA Primary

Addresses

Primary practice location

251 Cajon St
Suite B
Redlands, CA 92373-5260

Mailing address

251 Cajon St
Suite B
Redlands, CA 92373-5260
Phone (909) 793-7500

Other identifiers 1

IdentifierTypeStateIssuer
00G663180MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20171102001119 CA Practitioner - Nephrology 1254310014 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Southern California Keck School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

251 Cajon St
Suite B
Redlands, CA 92373-5260
Phone (909) 793-7500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18914CAMDAcupuncturist
66318CAMDPharmacist
G66318CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loma Linda University Medical Center Past Accepting new patients
Inland Nephrology Medical Associates, Inc. Nephrology PastSince Sep 23, 2017 Accepting new patients
Dignity Health Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 5

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322784000000",
    "number": "1972617413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 CAJON ST",
            "address_2": "SUITE B",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735260",
            "telephone_number": "909-793-7500",
            "fax_number": "909-798-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 CAJON ST",
            "address_2": "SUITE B",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735260",
            "telephone_number": "909-793-7500",
            "fax_number": "909-798-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKELY",
        "first_name": "PATRICIA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2011-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G66318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G663180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.