JEROME M BLAKE MD NPI 1699760546

NPI Information

NPI: 1699760546
Provider Name: JEROME M BLAKE, MD
Classification: Pediatrics - 2080P0008X
Entity Type: Individual

Specialization: Neurodevelopmental Disabilities

PECOS Registration: Yes

Address:
1600 W 22ND ST
SIOUX FALLS, SD
ZIP 57105
Phone: (605) 312-1000
Get Directions

Jerome M Blake, MD is a neurodevelopmental disabilities pediatrics in Sioux Falls, SD. The provider is a pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions. Jerome M Blake, MD NPI is 1699760546. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1600 W 22ND ST
SIOUX FALLS, SD
ZIP 57105-521
Phone: (605) 312-1000
Fax: (605) 312-1001

The NPI 1699760546 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/16/2005 and was last updated on 3/13/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080P0008X	Pediatrics	Neurodevelopmental Disabilities	2228	SOUTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	D25175	MEDICARE UPIN
2	S42191	MEDICARE PIN	SOUTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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