Jeffrey D. Blake, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Gardner, MA
NPI 1992792980 · NPPES record last updated Jun 20, 2011
Key facts
- NPI
- 1992792980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 78308 (MA)
- Practice address
- 250 Green St
Gardner, MA 01440-1396 - Phone
- (978) 630-5050
- Fax
- (978) 630-5059
- NPI assigned
- Oct 4, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Heywood Medical Group Inc.
Practice addresses (Care Compare)
242 Green St
Gardner, MA 01440-1336
250 Green St
Gardner, MA 01440-1396
Phone (978) 630-6460
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 82.98
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050426000858 | MA | Practitioner - Obstetrics/Gynecology | 2769421106 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78308 | MA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Heywood Memorial Hospital | Current |
Accepting new patients | |
| Athol Memorial Hospital Incorporated | Current |
Accepting new patients | |
| Henry Heywood Memorial Hospital | Current |
Accepting new patients | |
| Heywood Medical Group Inc. | Obstetrics & Gynecology | Current |
Accepting new patients |
Locations
2033 Main St
Athol, MA 01331
Phone (978) 249-1295
242 Green St
Gardner, MA 01440
Phone (978) 258-4734
250 Green St
Gardner, MA 01440
Phone (978) 630-5050
250 Green St
Ste 107
Gardner, MA 01440
Phone (978) 630-5050
Interoperability endpoints
- jeffrey.blake.1@192.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 78308 | MA | Yes |
Addresses
Primary practice location
250 Green St
Gardner, MA 01440-1396
Mailing address
250 Green St
Gardner, MA 01440-1396
Phone (978) 630-5050
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3118223 | Medicaid | MA |
Other providers in Gardner, MA
- Lynnette Bilodeau
- Kristine Marie Bissonnette
- Keith Jeremy Blackburn
- Gregory Andrew Blackman
- Stephen Charles Blais
- Julie Ann Blake
- Rebecca Ann Blodgett
- Sanjay Reddy Bommu
- Jack R Borey
- Emily Bostock
All providers in Gardner, MA · Obstetrics & Gynecology Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2011. 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.