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MR. BLAKE HAMILTON GILLIAM
NPI 1043845787
Nurse Practitioner in Madison, AL

Active since March 03, 2020Opted out of Medicare · through Nov 17, 2026
1230 SLAUGHTER RD STE C, MADISON, AL 35758(256) 325-0955 Get Directions Write a Review

NPPES record last updated: March 3, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Blake Hamilton Gilliam NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. BLAKE HAMILTON GILLIAM (NPI 1043845787) is an individual nurse practitioner in Madison, Alabama, licensed in Alabama (1-153719) and active in the NPI registry since March 2020. He has opted out of Medicare through November 17, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1043845787
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameMR. BLAKE HAMILTON GILLIAM
Location Address1230 SLAUGHTER RD STE CMadison, AL 35758-5901
Mailing Address1230 Slaughter Rd Ste CMadison, AL 35758-5901 · (256) 325-0955
Phone(256) 325-0955
Sole ProprietorYes
Enumeration DateMarch 3, 2020
NPPES CertifiedMarch 3, 2020
✔ NPI 1043845787 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in AL · 1-153719
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 1-153719 (AL)
Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X · License 1-153719 (AL)
1230 SLAUGHTER RD STE C, Madison, AL 35758
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mr. Blake Hamilton Gilliam has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 17, 2022 through November 17, 2026.

Opt-Out Effective DateNovember 17, 2022
Opt-Out In Effect ThroughNovember 17, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 35758 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.90 typical visit price
range $52.65 – $161.63
Typical copayment $20.47 (range $13.16 – $40.40)
Most-billed visit code 99203
Established Patient
$93.72 typical visit price
range $16.56 – $131.65
Typical copayment $23.43 (range $4.14 – $32.91)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADVENT HEALTH LLC
General Practice
1230 SLAUGHTER RD STE C
MADISON, AL 35758
Madison County (256) 325-0955
DR. CHAD JAMISON GILLIAM MMS, PA-C
Physician Assistant (Medical)
1230 SLAUGHTER RD STE C
MADISON, AL 35758
Madison County (256) 722-0555

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Gilliam's NPI number?

The NPI number for Blake Gilliam is 1043845787. It was assigned to this individual provider in the NPPES registry on March 3, 2020.

Where is Blake Gilliam located?

Blake Gilliam practices at 1230 Slaughter Rd Ste C, Madison, AL 35758. The listed phone number is (256) 325-0955.

What is Blake Gilliam's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Blake Gilliam enrolled in Medicare?

No. Blake Gilliam has opted out of Medicare through November 17, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Blake Gilliam was last updated on March 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.