BLAKE ALAN MASTALERZ MD
NPI 1093658411
Student in an Organized Health Care Education/Training Program in Memphis, TN

Q: What is Blake Mastalerz's NPI number?

The NPI number for Blake Mastalerz is 1093658411. It was assigned to this individual provider in the NPPES registry on April 10, 2026.

Q: What is Blake Mastalerz'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 Mastalerz was last updated on April 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 April 10, 2026PECOS Enrolled

920 MADISON AVE STE 447, MEMPHIS, TN 38103(901) 448-7635 Get Directions Write a Review

NPPES record last updated: April 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Blake Alan Mastalerz Md NPPES

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

BLAKE ALAN MASTALERZ MD (NPI 1093658411) is an individual student in an organized health care education/training program in Memphis, Tennessee and active in the NPI registry since April 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1093658411

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBLAKE ALAN MASTALERZCredential: MD

Location Address920 MADISON AVE STE 447Memphis, TN 38103-3438

Mailing Address920 Madison Ave Ste 447Memphis, TN 38103-3438 · (901) 448-7635

Phone(901) 448-7635

Sole ProprietorNo

Enumeration DateApril 10, 2026

NPPES CertifiedApril 10, 2026

✔ NPI 1093658411 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.

920 MADISON AVE STE 447, Memphis, TN 38103

Open in Google Maps ↗

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 Alan Mastalerz Md 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.

Leave this field empty

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.

DR. DAVID EDWARD ZIMMERHANZEL MD

Student in an Organized Health Care Education/Training Program