BLAKE ANDERSON DO
NPI 1063271641
Student in an Organized Health Care Education/Training Program in Saint Louis, MO

Q: What is Blake Anderson's NPI number?

The NPI number for Blake Anderson is 1063271641. It was assigned to this individual provider in the NPPES registry on March 18, 2024.

Q: What is Blake Anderson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Blake Anderson was last updated on March 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.

Active since March 18, 2024PECOS Enrolled

1402 S GRAND BLVD # M260, SAINT LOUIS, MO 63104(618) 210-5609 Get Directions Write a Review

NPPES record last updated: March 26, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 26, 2025, Jun 25, 2024 (2 updates tracked since 2024).

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About Blake Anderson Do NPPES

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

BLAKE ANDERSON DO (NPI 1063271641) is an individual student in an organized health care education/training program in Saint Louis, Missouri and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS and maintains a secondary practice location in Idaho Falls.

NPPES Registry Identity

NPI1063271641

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBLAKE ANDERSONCredential: DO

Location Address1402 S GRAND BLVD # M260Saint Louis, MO 63104-1004

Mailing Address3100 Channing WayIdaho Falls, ID 83404-7533

Phone(618) 210-5609

Sole ProprietorYes

Enumeration DateMarch 18, 2024

Last NPPES UpdateMarch 26, 20252 updates tracked since enumeration

NPPES CertifiedMarch 26, 2025

✔ NPI 1063271641 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedInternal MedicineTaxonomy 207R00000X · License MRO-2400 (ID)

1402 S GRAND BLVD # M260, Saint Louis, MO 63104

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Secondary Practice Location 1

Location 13100 Channing WayIdaho Falls, ID 83404-7533 · Phone (208) 227-2850

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blake Anderson Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

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

ANDRE CAMILLE JOSEPH III MD

Student in an Organized Health Care Education/Training Program