PENNY BLAKE APRN
NPI 1215489935
Nurse Practitioner - Family in Henderson, TX

Q: What is Penny Blake's NPI number?

The NPI number for Penny Blake is 1215489935. It was assigned to this individual provider in the NPPES registry on October 28, 2016.

Q: What is Penny Blake's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Penny Blake was last updated on August 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since October 28, 2016PECOS EnrolledAccepts Medicare Assignment

1600 US HIGHWAY 79 S, HENDERSON, TX 75654(903) 717-3260 Get Directions Write a Review

NPPES record last updated: August 7, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 7, 2024, Jun 17, 2020, Nov 9, 2016 and 1 more (4 updates tracked since 2016).

On this page

About Penny Blake Aprn NPPES

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

PENNY BLAKE APRN (NPI 1215489935) is an individual family provider in Henderson, Texas, licensed in Texas (AP132551) and active in the NPI registry since October 2016. She is enrolled in Medicare PECOS, is affiliated with Christus Good Shepherd Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1215489935

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NamePENNY BLAKECredential: APRN

Location Address1600 US HIGHWAY 79 SHenderson, TX 75654-4508

Mailing AddressPo Box 1022Waynesboro, TN 38485-1022 · (931) 722-2369

Phone(903) 717-3260

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateOctober 28, 2016

Last NPPES UpdateAugust 7, 20244 updates tracked since enumeration

NPPES CertifiedAugust 7, 2024

✔ NPI 1215489935 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in TX · AP132551

1600 US HIGHWAY 79 S, Henderson, TX 75654

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Secondary Practice Locations 2

Location 11107 E Marshall AveLongview, TX 75601-5602 · Phone (903) 758-2610 · Fax (903) 758-7081

Location 2703 E Marshall Ave Ste 4008Longview, TX 75601-5622 · Phone (903) 315-2729

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, CHRISTUS Health Plan, Medica and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Penny Blake Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254613615

PECOS Enrollment IDI20170119000245

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Christus Good Shepherd Medical Center

Acute Care Hospitals · Longview, TX

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number450032

Location700 E Marshall AveLongview, TX 75601 · Gregg County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75654 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

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

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 8

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

CRAIG EYE ASSOCIATES

Ophthalmology