Dr John S Blake, MD is a medicare enrolled "Dermatology - Mohs-micrographic Surgery" physician in Roosevelt, Utah. He went to University Of Utah School Of Medicine and graduated in 1988 and has 36 years of diverse experience with area of expertise as Dermatology. He is a member of the group practice Uintah Basin Medical Center, Northeastern Utah Medical Group and his current practice location is
210 W 300 N 7-3, Roosevelt, Utah. You can reach out to his office (for appointments etc.) via phone at
(435) 722-3971.
Dr John S Blake is licensed to practice in Utah (license number 49109901205) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1508826587.
Physician's Profile
Full Name | Dr John S Blake |
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Gender | Male |
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Speciality | Dermatology |
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Experience | 36 Years |
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Location | 210 W 300 N 7-3, Roosevelt, Utah |
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Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Dr John S Blake attended and graduated from University Of Utah School Of Medicine in 1988
NPI Data:
- NPI Number: 1508826587
- Provider Enumeration Date: 03/24/2006
- Last Update Date: 05/02/2017
Medicare PECOS Information:
- PECOS PAC ID: 3173651395
- Enrollment ID: I20100510000420
Medical Identifiers
Medical identifiers for Dr John S Blake such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1508826587 | NPI | - | NPPES |
D3948 | Medicaid | UT | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207ND0101X | Dermatology - Mohs-micrographic Surgery | 49109901205 (Utah) | Primary |
Medical Facilities Affiliation
Group Practice Association
Group Practice Name | Group PECOS PAC ID | No. of Members |
Uintah Basin Medical Center | 0244131944 | 56 |
Northeastern Utah Medical Group | 2961496609 | 42 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr John S Blake allows following entities to bill medicare on his behalf.
Entity Name | Uintah Basin Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1871556217 PECOS PAC ID: 0244131944 Enrollment ID: O20040226000948 |
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Entity Name | Northeastern Utah Medical Group |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1982664199 PECOS PAC ID: 2961496609 Enrollment ID: O20040414000471 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr John S Blake is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr John S Blake, MD 210 W 300 N 7-3, Roosevelt, UT 84066 Ph: (435) 722-3971 | Dr John S Blake, MD 210 W 300 N 7-3, Roosevelt, UT 84066 Ph: (435) 722-3971 |
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