Richard William Blake (NPI# 1740235829, PAC ID# 8527070655) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1740235829 |
| PAC ID by PECOS | 8527070655 |
| Professional Enrollment ID | I20060608000043 |
| Full Name | Richard William Blake |
| Organization Legal Name | URGENT CARE AT LAKE LUCILLE INC |
| Address |
185 E Parks Hwy Wasilla AK 99654-7038 |
| Phone Number | 9073734200 |
| Gender | M |
| Credential | PA |
| Medical School | UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE |
| Graduation Year | 2000 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 3274526546 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 020006 | MAT-SU REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 185 E Parks Hwy, Wasilla, AK 99654-7038 | 9073734200 | URGENT CARE AT LAKE LUCILLE INC |
| 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 9073735950 | COTTONWOOD CREEK CLINIC LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| MIPS_EC_130_overall | Documentation of Current Medications in the Medical Record | 100% |
| Organization Legal Name | URGENT CARE AT LAKE LUCILLE INC |
| Physicians | 8 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Louis M Packer | Family Medicine | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| John W Moore | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Leslie Dennis Tolliver Ii | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Tamara L Simpson | Nurse Practitioner | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Sarah Yvonne Blackburn Kehoe | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Richard T Combs | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Ashley F Marquardt | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Street Address |
185 E PARKS HWY |
| City | WASILLA |
| State | AK |
| Zip | 99654-7038 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Louis M Packer | Family Medicine | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| John W Moore | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Leslie Dennis Tolliver Ii | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Tamara L Simpson | Nurse Practitioner | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Sarah Yvonne Blackburn Kehoe | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Richard T Combs | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Ashley F Marquardt | Physician Assistant | Urgent Care At Lake Lucille Inc | 185 E Parks Hwy, Wasilla, AK 99654-7038 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Blaine G Upham | Chiropractic | 5461 E Mayflower Lane, Suite 6, Wasilla, AK 99654 | |
| Jeffrey A Lepage | Physical Therapy | First Choice Physical Therapy Inc | 6701 W Blondell St, Wasilla, AK 99654 |
| Trisha M Magee | Physical Therapy | Health Quest Therapy Inc | Mile 4, Wasilla, AK 99654 |
| Marlys F Bryan | Physical Therapy | Health Quest Therapy Inc | Mile 4, Wasilla, AK 99654 |
| Josh T Williams | Physical Therapy | First Choice Physical Therapy Inc | 6701 W Blondell St, Wasilla, AK 99654 |
| Amy L Stielstra | Physical Therapy | First Choice Physical Therapy Inc | 6701 W Blondell St, Wasilla, AK 99654 |
| Corissa J Abel | Physical Therapy | First Choice Physical Therapy Inc | 6701 W Blondell St, Wasilla, AK 99654 |
| Lisa M Bouyea-francies | Nurse Practitioner | Mat-su Health Services Inc. | 1363 W Spruce Ave, Wasilla, AK 99654-5327 |
| Robin Hughes | Clinical Social Worker | Mat-su Health Services Inc. | 1363 W Spruce Ave, Wasilla, AK 99654-5327 |
| Mary A Eckart | Physician Assistant | Mat-su Health Services Inc. | 1363 W Spruce Ave, Wasilla, AK 99654-5327 |
| Find all physicians in zip 99654 | |||
| City | WASILLA |
| Zip Code | 99654 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | WASILLA + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Richard William Blake.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.