Charles Edward Blake, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP2395 Issued in AZ

Practice address

17215 N 72ND Dr BLDG D
Glendale, AZ 85308-8558

Phone

(480) 214-9000

Fax

(480) 214-9999

NPI assigned

Dec 18, 2006

Last updated

May 9, 2024By 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

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Enticare PCGroup PAC ID 2264532779, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Enticare PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Chandler, AZ
  • NPI 1710014410
  Medicare reassignment Care Compare group NPD
• Home Health Resources, LLC

  dba THEMA Health Services

  • Home Health Agency
  • Phoenix, AZ
  • NPI 1477547123
  NPD (past)
• Optum Palliative and Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • Phoenix, AZ
  • NPI 1700815099
  NPD (past)
• Sjhmc Physician Services

  dba St. Joseph's Faculty Physicians

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1326098005
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1972666154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 W CHANDLER BLVD STE 5",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852246239",
            "telephone_number": "480-214-9000",
            "fax_number": "480-214-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17215 N 72ND DR BLDG D",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088558",
            "telephone_number": "480-214-9000",
            "fax_number": "480-214-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP2395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BL Med Spa LLC
• Cassandra Blackburn, RN
• Adam Bryce Blacker, O.D., M.S.
• Kimberly Irene Blahnik, LPN
• Cody Blair
• Sue Ellen Blakemore, M.N.S. , CCC
• Austin Blalock, PT
• Pamela Blanche, RN
• Guillermo E. Blanco, MR.
• Robin Blank, O.D.

• Family Nurse Practitioner in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.