BLAKE MIYAMOTO MD
NPI 1841091006
Student in an Organized Health Care Education/Training Program in Saint Louis, MO

Q: What is the provider's specialty?

The provider's specialty is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Active since March 24, 2025PECOS Enrolled

1201 S GRAND BLVD, SAINT LOUIS, MO 63104(314) 257-8000(314) 977-1664 Get Directions Write a Review

NPPES record last updated: March 24, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Blake Miyamoto Md NPPES

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

BLAKE MIYAMOTO MD (NPI 1841091006) is an individual student in an organized health care education/training program in Saint Louis, Missouri and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1841091006

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBLAKE MIYAMOTOCredential: MD

Location Address1201 S GRAND BLVDSaint Louis, MO 63104-1016

Mailing Address1008 S Spring AveSaint Louis, MO 63110-2520 · (314) 977-2605 · Fax (314) 977-1664

Phone(314) 257-8000

Fax(314) 977-1664

Sole ProprietorNo

Enumeration DateMarch 24, 2025

NPPES CertifiedMarch 23, 2025

✔ NPI 1841091006 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.

1201 S GRAND BLVD, Saint Louis, MO 63104

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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 Miyamoto 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.